title: Predictors identifying those at increased risk for STDs: a theory-guided review of empirical literature and clinical guidelines.
abstract: SummarySexually transmitted diseases (STDs) are leading causes of substantial morbidity worldwide. Identification of risk factors for estimating STD risk provides opportunities for optimising service delivery in clinical settings, including improving case finding accuracy and increasing cost-efficiency by limiting the testing of low-risk individuals. The current study was undertaken to synthesise the evidence supporting commonly cited chlamydia and gonorrhoea risk factors. The level of empirical support for the following predictors was strong/moderate: age, race/ethnicity, multiple lifetime sexual partners, sex with symptomatic partners and concurrent STD diagnosis. The following predictors had weak evidence: socio-economic status, transactional sex, drug/alcohol use, condom use and history of STD diagnosis. The most frequently listed predictors among nine clinical guidelines were younger age and multiple sexual partners; the least consistently listed predictor was inconsistent condom use. We found reasonably good concordance between risk factors consistently listed in the recommendations and predictors found to have strong empirical support in the literature. There is a need to continue building the evidence base to explicate the mechanisms and pathways of STD acquisition. We recommend periodic reviews of the level of support of predictors included in clinical guidelines to ensure that they are in accordance with empirical evidence.
authors.affiliation: The School of Population and Public Health, University of British Columbia, Vancouver, BC, Canada lola.falasinnu@ubc.ca.
authors.forename: Titilola
authors.initials: T
authors.lastname: Falasinnu
authors.affiliation: British Columbia Centres for Disease Control, Vancouver, BC, Canada.
authors.forename: Mark
authors.initials: M
authors.lastname: Gilbert
authors.affiliation: British Columbia Centres for Disease Control, Vancouver, BC, Canada.
authors.forename: Travis Salway
authors.initials: TS
authors.lastname: Hottes
authors.affiliation: The Department of Statistics, University of British Columbia, Vancouver, BC, Canada.
authors.forename: Paul
authors.initials: P
authors.lastname: Gustafson
authors.affiliation: British Columbia Centres for Disease Control, Vancouver, BC, Canada.
authors.forename: Gina
authors.initials: G
authors.lastname: Ogilvie
authors.affiliation: The School of Population and Public Health, University of British Columbia, Vancouver, BC, Canada.
authors.forename: Jean
authors.initials: J
authors.lastname: Shoveller
mesh_terms: D000328:Adult; D000367:Age Factors; D002690:Chlamydia Infections / Q000517:prevention & control*; D017280:Condoms / Q000706:statistics & numerical data; D005260:Female; D006069:Gonorrhea / Q000517:prevention & control*; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D008297:Male; D012307:Risk Factors; D012725:Sexual Behavior; D012747:Sexual Partners; D012749:Sexually Transmitted Diseases / Q000517:prevention & control
keywords: STD; STI; Sexually transmitted diseases; chlamydia; clinical guidelines; epidemiology; gonorrhoea; predictors; risk assessment; risk factors; screening recommendations; selective testing; sexually transmitted infections