31st August 2018,
Hayley J Denison, Lisa Woods, Collette Bromhead, Jane Kennedy, Rebecca Grainger, Annemarie Jutel, Elaine M Dennison
Sexually transmitted infections (STIs) can lead to serious health complications including pelvic inflammatory disease, infertility and adverse pregnancy outcomes, as well as increased susceptibility to further STI acquisition including human…
The full contents of this page is only available to subscribers.
To view this content please login or subscribe
Untreated sexually transmitted infections (STIs) can lead to serious health complications and may be transmitted to uninfected individuals. Prior to this study, time to presentation for STI symptoms and risk of transmission in this period had not been assessed in New Zealand. This research surveyed people attending a sexual health clinic (SHC) in Wellington, New Zealand. In total, 243 people took part. The most common reason for seeking healthcare was experiencing symptoms. 41.7% of people with symptoms waited more than seven days to seek healthcare. Almost a third of people with symptoms had sex after they first thought they may need to seek healthcare. This work suggests more could be done to help people attend healthcare quicker when they experience symptoms suggestive of an STI. Some possible options could be a public health campaign explaining why taking swift action is important, or providing support and guidance to help people navigate the healthcare system.
Untreated sexually transmitted infections (STIs) can lead to serious health complications and may be transmitted to uninfected individuals. Therefore, the early detection and subsequent management of STIs is crucial to control efforts. Time to presentation for STI symptoms and risk of transmission in this period has not been assessed in New Zealand to date.
All new clients presenting to an urban sexual health clinic (SHC) were invited to complete a questionnaire, which included demographic information, sexual health history, and details about the clinic visit.
Of 331 people approached, 243 (73.4%) agreed to complete the questionnaire. Four incomplete questionnaires were excluded, leaving 239 participants (47.3% female and 52.7% male, 43.8% under the age of 25). The most common reason for seeking healthcare was experiencing symptoms (39.4%) and 41.7% of people with symptoms waited more than seven days to seek healthcare. Around a third (30.6%) of people with symptoms had sex after they first thought they may need to seek healthcare. Infrequent condom use was reported more often by people who had sex with existing partners (84.6%) than by people who had sex with new partners (10.0%).
This is the first study to quantify healthcare-seeking behaviour for STI in New Zealand. Delayed healthcare-seeking (defined as waiting more than seven days) was common and almost a third of people reported engaging in sex while symptomatic. Enabling prompt healthcare-seeking is crucial to minimise transmission risk. Structural barriers such as the financial cost of STI tests must be removed and education around symptom recognition and healthcare system navigation should be provided.
- Haggerty CL, Gottlieb SL, Taylor BD, Low N, Xu F, Ness RB. Risk of sequelae after Chlamydia trachomatis genital infection in women. J Infect Dis.2010;201 Suppl 2:S134–55.
- Idahl A, Boman J, Kumlin U, Olofsson JI. Demonstration of Chlamydia trachomatis IgG antibodies in the male partner of the infertile couple is correlated with a reduced likelihood of achieving pregnancy. Hum Reprod 2004; 19(5):1121–6.
- Ward H, Ronn M. Contribution of sexually transmitted infections to the sexual transmission of HIV. Curr Opin HIV AIDS 2010; 5(4):305–10.
- Akinnawo EO, Oguntimehin F. Health-seeking behaviour of STD patients in an urban area of southwest Nigeria: an exploratory study. Health Transit Rev 1997; 7 Suppl:307–13.
- Hook EW, 3rd, Richey CM, Leone P, Bolan G, Spalding C, Henry K, et al. Delayed presentation to clinics for sexually transmitted diseases by symptomatic patients. A potential contributor to continuing STD morbidity. Sex Transm Dis 1997; 24(8):443–8.
- Fortenberry JD. Health care seeking behaviors related to sexually transmitted diseases among adolescents. Am J Public Health 1997; 87(3):417–20.
- Leenaars PR. Rombouts B, Kok G. Seeking medical care for a Sexually Transmitted Disease: Determinants of delay-behavior. Psychol Health 1993; 8(1):17–32.
- Khan A, Fortenberry JD, Temkit MH, Tu W, Orr DP, Batteiger BE. Gender differences in sexual behaviours in response to genitourinary symptoms. Sex Transm Infect 2005; 81(3):262–6.
- Voeten HA, O’Hara H B, Kusimba J, Otido JM, Ndinya-Achola JO, Bwayo JJ, 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):265–72.
- Irwin DE, Thomas JC, Spitters CE, Leone PA, Stratton JD, Martin DH, et al. Self-reported sexual activity and condom use among symptomatic clients attending STD clinics. Sex Transm Dis 1999; 26(5):286–90.
- Moses S, Ngugi EN, Bradley JE, Njeru EK, Eldridge G, Muia E, et al. Health care-seeking behavior related to the transmission of sexually transmitted diseases in Kenya. Am J Public Health 1994; 84(12):1947–51.
- Ireland JA, Reid M, Powell R, Petrie KJ. The role of illness perceptions: psychological distress and treatment-seeking delay in patients with genital warts. Int J STD AIDS 2005; 16(10):667–70.
- ESR Annual Surveillance Report - Sexually Transmitted Infections in New Zealand, 2013. Porirua, New Zealand: The Institute of Environmental Science and Research Ltd; 2014.
- Mercer CH, Sutcliffe L, Johnson AM, White PJ, Brook G, Ross JD, et al. How much do delayed healthcare seeking, delayed care provision, and diversion from primary care contribute to the transmission of STIs? Sex Transm Infect 2007; 83(5):400–5.
- Aicken CR, Cassell JA, Estcourt CS, Keane F, Brook G, Rait G, et al.Rationale and development of a survey tool for describing and auditing the composition of, and flows between, specialist and community clinical services for sexually transmitted infections. BMC Health Serv Res 2011; 11:30.
- Cormack D, Robson, C. Classification and output of multiple ethnicities: considerations for monitoring Māori Health. Wellington: Te Rōpū Rangahau Hauora a Eru Pōmare; 2010.
- Malek AM, Chang CC, Clark DB, Cook RL. Delay in Seeking Care for Sexually Transmitted Diseases in Young Men and Women Attending a Public STD Clinic. Open AIDS J 2013; 7:7–13.
- Mercer CH, Aicken CR, Estcourt CS, Keane F, Brook G, Rait G, et al. Building the bypass-implications of improved access to sexual healthcare: evidence from surveys of patients attending contrasting genitourinary medicine clinics across England in 2004/2005 and 2009. Sex Transm Infect 2012; 88(1):9–15.
- Denison HJ, Bromhead C, Grainger R, Dennison EM, Jutel A. Barriers to sexually transmitted infection testing in New Zealand: a qualitative study. Aust N Z J Public Health 2017; 41(4):432–7.
- Fonck K, Mwai C, Ndinya-Achola J, Bwayo J, Temmerman M. Health-seeking and sexual behaviors among primary healthcare patients in Nairobi, Kenya. Sex Transm Dis 2002; 29(2):106–11.
- Thi Thu H, Ziersch A, Hart G. Healthcare-seeking behaviours for sexually transmitted infections among women attending the National Institute of Dermatology and Venereology in Vietnam:Sex Transm Infect.2007; 83(5):406–10.
- Tipene J, Green A. He Pūkenga Kōrero. Rangatahi and sexually transmitted infections in the Waikato. A report submitted to the Health Research Council of New Zealand. 2017 Aug.
- Catchpole M, Connor N, Brady A, Kinghorn G, Mercey D, Band B, et al. Behavioural and demographic characteristics of attenders at two genitourinary medicine clinics in England. Genitourin Med 1997; 73(6):457–61.
- ESR Annual Surveillance Report - Sexually Transmitted Infections in New Zealand, 2014. Porirua, New Zealand: The Institute of Environmental Science and Research Ltd; 2015.
- Ward J, McGregor S, Guy RJ, Rumbold AR, Garton L, Silver BJ, et al. STI in remote communities: improved and enhanced primary health care (STRIVE) study protocol: a cluster randomised controlled trial comparing 'usual practice' STI care to enhanced care in remote primary health care services in Australia. BMC Infect Dis. 2013; 13:425.
The downloadable PDF version of this article is only available to subscribers.
To view this content please login or subscribe