Care Seeking Patterns of STIs-Associated Symptoms in Iran: Findings of a Population-Based Survey

Document Type: Original Article

Authors

1 Regional Knowledge Hub, and WHO Collaborating Centre for HIV Surveillance, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran

2 School of Population and Public Health, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada

3 Center for Disease Control (CDC), Ministry of Health and Medical Education, Tehran, Iran

4 Department of Biostatistics and Epidemiology, Faculty of Public Health, Kerman University of Medical Sciences, Kerman, Iran

5 Research Center for Modeling in Health, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran

6 Guilan Road Trauma Research Center, Guilan University of Medical Science, Guilan, Iran

7 Global Health Sciences Department, University of California, San Francisco, CA, USA

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 STIsassociated 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).
 
Conclusion
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.

Keywords

Main Subjects


  1. Sangani P, Rutherford G, Wilkinson D. Population-based interventions for reducing sexually transmitted infections, including HIV infection. Cochrane Database Syst Rev. 2004;(2):CD001220.
  2. Rottingen JA, Cameron DW, Garnett GP. A systematic review of the epidemiologic interactions between classic sexually transmitted diseases and HIV: how much really is known? Sex Transm Dis. 2001;28(10):579-597. doi:10.1097/00007435-200110000-00005
  3. Buchacz K, Patel P, Taylor M, et al. Syphilis increases HIV viral load and decreases CD4 cell counts in HIV-infected patients with new syphilis infections. AIDS. 2004;18(15):2075-2079. doi: 10.1097/00002030-200410210-00012
  4. Meheus A. Women’s health: importance of reproductive tract infections, pelvic inflammatory disease and cervical cancer. In: Germain A, Holmes KK, Piot P, Wasserheit  JN, eds. Reproductive Tract Infections. Springer; 1992:61-91. doi:10.1007/978-1-4899-0691-5_4
  5. World Health Organization (WHO). Facing the challenges of HIV/AIDS/STDs: a gender-based response. http://data.unaids.org/topics/gender/facingchallenges_en.pdf. Accessed June 10,  2014. Published 2015.
  6. Mamdani M, Bangser M. Poor people's experiences of health services in Tanzania: a literature review. Reprod Health Matters. 2004;12(24):138-153.
  7. Rani M, Bonu S. Rural Indian women's care‐seeking behavior and choice of provider for gynecological symptoms. Stud Fam Plann. 2003;34(3):173-185.
  8. Makhlouf Obermeyer C, Ghorayeb F, Reynolds R. Symptom reporting around the menopause in Beirut, Lebanon. Maturitas. 1999;33(3):249-258. doi:10.1016/S0378-5122(99)00049-3
  9. Obermeyer CM. Menopause across cultures: a review of the evidence. Menopause. 2000;7(3):184-192.
  10. Ghanaat J, Afshari JT, Ghazvini K, et al. Prevalence of genital Chlamydia in Iranian males with urethritis attending clinics in Mashhad. East Mediterr Health J. 2008;14(7):1333-1337.
  11. Matini M, Rezaie S, Mohebali M, et al. Prevalence of Trichomonas vaginalis Infection in Hamadan City, Western Iran. Iranian J Parasitol. 2012;7(2):67-72.
  12. Ndowa F, Bozicevic I, Mirzazadeh A, Larisa P. Report of a WHO Consultation to Review Survillance for Sexually Transmitted Infectionsin Iran. Iran, Tehran: Ministry of Health and Medical Education, CDC; 2011.
  13. Haghdoost AA, Baneshi MR, Eybpoosh S,  Khajehkazemi R. Comparison of three interview methods on response pattern to sensitive and non-sensitive questions. Iran Red Crescent Med J. 2013;15(6):500-506. doi:10.5812/ircmj.7673
  14. Wood K, Aggleton P. Promoting young peoples sexual and reproductive health, Stigma discrimination and human rights. Thomas Coram Research Unit, Institute of Education, University of London; 2002.
  15. Swendeman D, Rotheram-Borus MJ, Comulada S, Weiss R, Ramos ME. Predictors of HIV-related stigma among young people living with HIV. Health Psychol. 2006;25(4):501.
  16. Voeten HA, O'hara HB, Kusimba J, et al. Gender differences in health care-seeking behavior for sexually transmitted diseases: a population-based study in Nairobi, Kenya. Sex Transm Dis. 2004;31(5):265-272.
  17. Fauci AS, Braunwald E, Kasper DL, et al. Sexually transmitted diseases and reproductive tract infections. In: Anthony Fauci AS, Braunwald E, Kasper DL, eds. Harrison's Manual of Medicine. 17 ed. New York: McGraw-Hill; 2009.
  18. Bertakis KD, Azari R, Helms LJ, et al. Gender differences in the utilization of health care services. J Fam Pract. 2000;49(2):147-152.
  19. Tilson EC, Sanchez V, Ford CL, et al. Barriers to asymptomatic screening and other STD services for adolescents and young adults: focus group discussions. BMC Public Health. 2004;21:4. doi:10.1186/1471-2458-4-21
  20. Khan AA, Rehan N, Qayyum K,  Khan A. Care seeking for STI symptoms in Pakistan. J Pak Med Assoc. 2009;59(9):628.
  21. Nuwaha F. Determinants of choosing public or private health care among patients with sexually transmitted infections in Uganda. Sex Transm Dis.  2006;33(7):422-427.
  22. El-Kak F, Khawaja M, Salem M,  Zurayk H. Care-seeking behavior of women with reproductive health problems from low-income areas of Beirut. Int J Gynaecol Obstet. 2009;104(1):60-63. doi:10.1016/j.ijgo.2008.09.006
  23. Manhart LE, Dialmy A, Ryan CA, et al. Sexually transmitted diseases in Morocco: gender influences on prevention and health care seeking behavior. Soc Sci Med. 2000;50(10):1369-1383. doi:10.1016/S0277-9536(99)00398-6
  24. Gordon SM, Mosure DJ, Lewis J, et al. Prevalence of self-medication with antibiotics among patients attending a clinic for treatment of sexually transmitted diseases. Clin Infect Dis. 1993;17(3):462-465.
  25. Irwin DE, Thomas JC, Spitters CE, et al. Self-Treatment patterns among clients attending sexually transmitted disease clinics and effect of self-treatment on STD symptom durartion. Sex Transm Dis. 1997;24(9):372-377.
  26. Sharifi A, Sharifi H, Karamouzian M, et al. Topical ocular anesthetic abuse among Iranian welders: Time for action. Middle East Afr J Ophthalmol. 2013;20(4):336. doi:10.4103/0974-9233.120023
  27. Nasiripour A, Abedi, Tavana M. Relationship of services utility with patients tending to hospitals. Iran J Health Sci. 2013;1(2):61-67.
  28. Karamouzian M, Shokoohi M. Sexual and reproductive health education in Iranian schools. J Adolesc Health. 2014;55(1):149-150. doi:10.1016/j.jadohealth.2014.04.009