title: Care Seeking Patterns of STIs-Associated Symptoms in Iran: Findings of a Population-Based Survey.
abstract: BACKGROUND
  Understanding the prevalence of symptoms associated with sexually transmitted infections (STIs) and how care is sought for those symptoms are important components of STIs control and prevention. People's preference between public and private service providers is another important part of developing a well-functioning STIs surveillance system.
  
  
  METHODS
  This cross-sectional survey was carried out in spring 2011, using a nonrandom quota sample of 1190 participants (52% female) in 4 densely-populated cities of Tehran, Kerman, Shiraz, and Babol. Two predictive logistic regression models were constructed to assess the association between the socio-demographic determinants (independent variables) and the dependent variables of history of STIs-associated symptom and seeking care.
  
  
  RESULTS
  Around 57% (677 out of 1190; men: 29.70% and women: 81.80%) had experienced at least one STIs-associated symptom during the previous year. History of experiencing STIs-associated symptoms among men, was negatively significantly associated with older age (adjusted odds ratio [AOR] = 0.34, CI 95%: 0.17-0.67). Women who were married, in older ages, and had higher educations were more likely to report a recent (past year) STIs symptom, however all were statistically insignificant in both bivariate and multivariable models. Among those who have had STIs-associated symptoms in the last year, 31.15% did nothing to improve their symptoms, 8.03% attempted self-treatment by over-the-counter (OTC) medications or traditional remedies, and 60.93% sought care in health facilities. In both bivariate and multivariable analyses, care seeking among men was insignificantly associated with any of the collected demographic variables. Care seeking among women was positively significantly associated with being married (AOR = 2.48, 95% CI: 1.60-3.84).
  
  
  CONCLUSIONS
  The reported prevalence of STIs-associated symptoms among our participants is concerning. A considerable number of participants had delayed seeking care and treatment or self-medicated. People should be informed about their sexual health and the consequences of delaying or avoiding seeking care for STIs. Participants preferred seeking care at private sectors which calls for engaging both public and private health sectors for reporting and following up STIs cases.
authors.affiliation: Regional Knowledge Hub, and WHO Collaborating Centre for HIV Surveillance, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran.
authors.forename: Maryam
authors.initials: M
authors.lastname: Nasirian
authors.affiliation: Regional Knowledge Hub, and WHO Collaborating Centre for HIV Surveillance, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran.|School of Population and Public Health, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada.
authors.forename: Mohammad
authors.initials: M
authors.lastname: Karamouzian
authors.affiliation: Center for Disease Control (CDC), Ministry of Health and Medical Education, Tehran, Iran.
authors.forename: Kianoush
authors.initials: K
authors.lastname: Kamali
authors.affiliation: Department of Biostatistics and Epidemiology, Faculty of Public Health, Kerman University of Medical Sciences, Kerman, Iran.
authors.forename: Amir Reza
authors.initials: AR
authors.lastname: Nabipour
authors.affiliation: Research Center for Modeling in Health, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran.
authors.forename: Ahmad
authors.initials: A
authors.lastname: Maghsoodi
authors.affiliation: Research Center for Modeling in Health, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran.
authors.forename: Roja
authors.initials: R
authors.lastname: Nikaeen
authors.affiliation: Guilan Road Trauma Research Center, Guilan University of Medical Science, Guilan, Iran.
authors.forename: Ali Reza
authors.initials: AR
authors.lastname: Razzaghi
authors.affiliation: Global Health Sciences Department, University of California, San Francisco, CA, USA.|Regional Knowledge Hub, and WHO Collaborating Centre for HIV Surveillance, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran.
authors.forename: Ali
authors.initials: A
authors.lastname: Mirzazadeh
authors.affiliation: Research Center for Modeling in Health, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran.
authors.forename: Mohammad Reza
authors.initials: MR
authors.lastname: Baneshi
authors.affiliation: Research Center for Modeling in Health, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran.
authors.forename: Ali Akbar
authors.initials: AA
authors.lastname: Haghdoost
mesh_terms: D000293:Adolescent; D000328:Adult; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D007492:Iran / Q000453:epidemiology; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D010342:Patient Acceptance of Health Care / Q000706:statistics & numerical data*; D015995:Prevalence; D012307:Risk Factors; D012749:Sexually Transmitted Diseases / Q000453:epidemiology*; D011795:Surveys and Questionnaires; D055815:Young Adult
keywords: Care-Seeking; Epidemiology; Iran; Sexually Transmitted Infections (STIs); Symptoms