Research article
Misconceptions about STD-protective behavior

https://doi.org/10.1016/S0749-3797(00)00194-XGet rights and content

Abstract

Context: Misconceptions about STD-protective behaviors have not been studied before and after STD counseling. Further, to the best of our knowledge, the relationship of these misconceptions to condom use and STD incidence has not previously been described in published reports.

Objectives: The main purpose of the study was to determine the prevalence of misconceptions about STD prevention among STD clinic attendees (N=3498) in five large cities, as well as whether misconceptions decreased after STD diagnosis, STD counseling, or both. The study also identified predictors of persistent misconceptions and determined the relationship of STD incidence and unprotected sex to persistent misconceptions.

Methods: Data from a randomized controlled trial evaluating HIV/STD counseling interventions (Project RESPECT) were used for the present analyses. Participants completed an interview upon study enrollment and every 3 months following enrollment for a 1-year period. A portion of the interview assessed participants’ misconceptions about STD-protective behaviors.

Results: At baseline, 16.3% believed that washing the genitals after sex protected from STDs. Likewise, urinating after sex (38.7%), douching (45.7%), and use of oral contraceptives (19.9%) were believed to prevent STDs. Prevalence of misconceptions was significantly diminished at a 3-month follow-up (p<.001). Those continuing to have misconceptions were more likely to be aged ≥24 and African American. Those continuing to have these misconceptions did not have higher STD incidence.

Conclusions: Misconceptions about STD-protective behaviors are common, and the event of an STD or STD counseling or both generally reduces these misconceptions. Although these misconceptions may not directly translate into risky behavior, they may preclude movement toward safer sex.

Introduction

D uring 1997 in the United States, more than 500,000 cases of chlamydia, more than 300,000 cases of gonorrhea, and more than 8000 cases of primary or secondary syphilis were reported to the Centers for Disease Control and Prevention (CDC).1 Estimates of actual numbers of all cases of sexually transmitted diseases (STDs) occurring each year now exceed 15 million.2 In 1995, five of the top ten most commonly reported infectious diseases in the United States were sexually transmitted.3

Past studies have overwhelmingly supported the value of behavioral interventions for reducing frequency of risky sexual behaviors, in contrast to knowledge-only interventions.4, 5, 6, 7, 8, 9 However, correct knowledge about methods of preventing STDs is an essential starting point in the behavior-change process for individuals who have misconceptions about behaviors that prevent STD infection. Such misconceptions may lead to the use of ineffective STD-protective strategies in place of effective, but less acceptable strategies (e.g., douching instead of condom use).

A recent study of more than 1500 low-income women in Missouri showed that nearly 10% had douched at some time as a method of preventing HIV infection; nearly 20% reported using oral or injectable hormonal contraceptives as a method of HIV prevention.10 In another recent study, 68% of 650 female adolescents reported believing that douching prevents STD infection and 60% of the sample reported believing that oral contraceptives prevent STD infection.11 High prevalence of general misconceptions about methods of preventing STDs has been documented in other studies.12, 13

Misconceptions about STD prevention can be traced back to a time when a variety of incorrect prevention strategies were advocated. For example, the U.S. Navy once advocated the use of a post-exposure prophylactic soap applied to the penis as a means of preventing syphilis and gonorrhea (The Sanitube Company, Radio Circle, Mt. Kisco, NY, Sanitube venereal prophylactic technical data, unpublished observations, date unknown). In 1933, the American Medical Association published a pamphlet that included advice to wash “exposed parts” if exposure to venereal disease (VD) were suspected.14 In 1937, the Alabama State Board of Health published a pamphlet emphasizing the STD-protective value of urinating and washing after “exposure.”15 In 1945, the U.S. Public Health Service published a VD case-finding manual for use in training programs. A section of this manual provided VD-prophylactic guidelines from the American Social Hygiene Association. These guidelines instructed that washing the genitals with soap and hot water after sex should be performed as a method of VD protection if a condom is not used.16 More recently, the Internet is a source of misinformation about STD prevention, with at least one website advocating thorough washing of the genitals and urinating after sex to prevent STDs.17 Although soap may have some protective value against sexually transmitted agents, including enveloped viruses,18 scant evidence exists that simply washing the genitals provides much protection after exposure to an STD.

To our knowledge, misconceptions about STD-protective behaviors have not been studied before and after STD counseling. In addition, the relationship of these misconceptions to condom use and STD incidence has not previously been described in published reports.

The purpose of this study was to assess the prevalence of selected misconceptions about STD prevention among a sample of people attending STD clinics in five large metropolitan areas. In addition, the study tested the hypothesis that prevalence of these misconceptions would decrease following STD diagnosis and counseling. We also identified variables that predicted having misconceptions at baseline interview and at the end of a 1-year period. The hypothesis that having misconceptions is related to unprotected vaginal sex and to increased STD incidence was also tested.

Section snippets

Procedures

Data for the present analyses derived from Project RESPECT, a multi-center, randomized controlled trial evaluating the efficacy of three HIV/STD counseling approaches in reducing risky behaviors and new STDs and HIV. Project RESPECT demonstrated that two brief, interactive counseling sessions aimed at personal risk reduction were significantly more effective than two informational sessions. Informational “counseling” is the approach that has typically been used in the context of HIV testing.

Prevalence and declines in misconceptions

Table 2 displays the number and percentage of participants having misconceptions at baseline and the decline in this prevalence at the 3-month follow-up. All declines were significant at p≤0.001. At baseline, misconceptions about douching were common, with about 46% of the sample believing that douching protected from STD infection (more common among men [59%] than women [41%]; p≤0.001). About 39% of the sample believed that urinating after sex protected from STD infection; about 20% believed

Discussion

The most striking finding was the high prevalence of basic misconceptions about behaviors that prevent STD infection. On average, about four of every ten participants initially believed that STD infection could be prevented by urinating after sex. Nearly half of the sample initially believed that douching protects against STDs and about one fifth of the sample initially believed that use of oral contraceptives protects against STDs. About one of every six participants initially believed that

Acknowledgements

We are grateful to the study participants who volunteered for Project RESPECT and to our counselors and research clinical staff in Baltimore, Denver, Long Beach, Newark, and San Francisco. The members of the Project RESPECT study team are as follows: Baltimore— Carolyn Erwin-Johnson, MA, Andrew L. Lentz, MPA, Mary A. Staat, MD, MPH, Dawn Sweet, PhD, and Jonathon M. Zenilman, MD (principal investigator, PI); Denver—John M. Douglas, Jr., MD (PI), Tamara Hoxworth, PhD, Ken Miller, MPH, and William

References (24)

  • Centers for Disease Control and Prevention. Sexually transmitted diseases surveillance, 1997. Atlanta, GA: U.S....
  • W. Cates

    Estimates of the incidence and prevalence of sexually transmitted diseases in the United States

    Sex Transm Dis

    (1999)
  • R.J. DiClemente et al.

    A randomized controlled trial of an HIV sexual risk-reduction intervention for young African American women

    JAMA

    (1995)
  • T.J. Coates et al.

    Designing behavioural and social science to impact practice and policy in HIV prevention and care

    Int J STDs AIDS

    (1996)
  • M.L. Kamb et al.

    Efficacy of risk-reduction counseling to prevent human immunodeficiency virus and sexually transmitted diseasesa randomized controlled trial

    JAMA

    (1998)
  • J.A. Kelly et al.

    The effects of HIV/AIDS intervention groups for high-risk women in urban clinics

    Am J Public Health

    (1994)
  • J.B. Jemmott et al.

    Reduction in HIV risk associated sexual behaviors among black male adolescentseffects of an AIDS prevention intervention

    Amer J Public Health

    (1992)
  • R.N. Shain et al.

    A randomized, controlled trial of a behavioral intervention to prevent sexually transmitted disease among minority women

    New Engl J Med

    (1999)
  • R.A. Crosby et al.

    Prevention strategies other than male condoms employed by low-income women to prevent HIV infection

    Public Health Nurs

    (2000)
  • Bunnell R, Dahkberg L, Stone D, Rolfs R, St. Louis M. Misconceptions about STD prevention and associations with STD...
  • D. Koniak-Griffin et al.

    AIDS risk behaviors, knowledge, and attitudes among pregnant adolescents and young mothers

    Health Educ Behavior

    (1997)
  • Cited by (24)

    View all citing articles on Scopus
    View full text