Adherence to STD Post-Treatment Recommendations Among Young African-American Women

Background: Nationally, rates of chlamydia and gonorrhea are increasing in the United States, and rates are highest among young African-American women.  To minimize transmission, national sexually transmitted disease (STD) treatment guidelines recommend individuals treated for chlamydia and gonorrhea abstain from sexual activity for 7 days after treatment.  This study sought to explore the extent to which young STD-positive African-American women adhere to these recommendations.

Methods: As part of a larger study, African-American women (ages 18-24 years) were tested for chlamydia, gonorrhea, and trichomonas. Forty women assigned to an active STD prevention intervention conditions who were newly diagnosed with chlamydia or gonorrhea between June 2012 and August 2014 were included in this study. Participants received directly-observed single-dose treatment and nurse counseling according to national treatment guidelines. Seven days later participants completed audio computer-assisted self-interviews about their recent sexual behaviors.

Results:  Nearly all (95%) reported disclosing their STD status to all of their sexual partners, and 67.5% reported their partners were treated. Participants reported being told by the nurse to wait at least 1 week before having sex (95%). Yet, 30% had vaginal sex with at least 1 partner in the 7-day period, 10% had vaginal sex with a new partner, and only 36% used a condom every time. Additionally, 50% of those who gave or received oral sex within the 7-day period did not use a condom.   

Conclusions: Despite their reported knowledge of abstinence recommendations, participants still engaged in unprotected sexual behavior immediately post-treatment. This highlights a lack of understanding of transmission dynamics and perhaps low self-efficacy to adhere to STD treatment guidelines. Further exploration into the barriers young women face to adhere to STD treatment recommendations is necessary to reduce incident and repeat STD diagnoses in this population.