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Abstract

Sexually transmitted infections (STIs) affect an estimated 347 million people worldwide. These diseases can be spread asymptomatically, and can potentially incur significant long-term negative health outcomes, including lifetime treatment regimens, cancer, or infertility. The severity of these outcomes, clinical manifestations, and overall acquisition rates show a sexually dimorphic variability, with women experiencing a higher burden of these diseases than men. While the exact mechanism for this disparity is unknown, it is likely due to a combination of biological and social influences. This study investigates several of these gendered variables, particularly those involving birth control and sexual healthcare, and their relationship with STI acquisition. We investigated sexual dimorphism in STI rates, along with different self-reported factors regarding sexual and reproductive health experiences and preferences, social demographics, and sexual behaviors using two sources for data analysis, the National Health and Nutritional Examination Survey (NHANES), and a cross-sectional sexual health survey disseminated to college women in North Carolina. NHANES analysis did correspond with what had been stated in previous literature. We concluded that women in the United States follow the classic gendered trend with higher rates of STIs than men (p<0.0001). The sexual health survey results included information from women (n=522), 18-53 years old, who were sexually active. We found significant associations regarding a positive self-reported STI history with birth control type (p=0.0386), contraceptive hormone type (p=0.0200), frequency of STI screening (p<0.0001), and the number of previous sexual partners (p<0.0001), however interaction analysis limited the significance to sexual partner number (OR 1.098, CI [1.065-1.131]) and inconsistent screening frequency (OR 0.194, CI [0.057-0.664]). We also found initial associations between women who use some form of hormonal contraceptive with condom use (p<0.0001), STI screening frequency (p=0.0003), and age (p<0.0001). Multivariate analysis corresponded with these initial assessments in regards to women who consistently use condoms (OR 0.253, CI [0.155-0.413]), demonstrate inconsistent screening (OR 0.261, CI [0.155-0.704]), and age (OR 0.827, CI [0.778-0.878]). Our free-response questions also gave us insight into personal opinions of several aspects of sexual health and STIs, including qualitative discussion regarding overall comfort with sexual health medical personnel, their feelings regarding positive STI diagnosis, and their interpretation of the physician’s approach toward the positive STI history. This study addressed several variables associated with women's sexual health care and outcomes and was able to identify several risk factors that may influence the sex disparity seen in STI prevalence. Continued research is necessary to develop more personalized treatments, prevention strategies, and interventions to improve sexual health education, provider-patient relationships, and overall health outcomes.

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