Zike et al.

Reproductive Health (2022) 16:163

Page 1 |
doi:10.1186/s12978-022-0815-5

PREVALENCE OF SEXUALLY TRANSMITTED INFECTIONS AND ASSOCIATED

FACTORS AMONG THE UNIVERSITY STUDENTS
1Zike, K. E., 2Awopeju A.T.O 3 Bademosi A., 1Ossai-Chidi L. N.,

Abstract
Introduction: Globally, sexually transmitted infections (STIs) remain a major public health
problem. University students tend to practices sex which predisposes them to sexually
transmitted infections, unwanted pregnancies, and unsafe abortions due to their freedom
from families. Therefore, the study aimed to assess the prevalence of sexually transmitted
infections and associated factors among the University students in Port Harcourt, Nigeria
Methods: An institution based cross-sectional study was conducted on 845 University of
Port Harcourt students selected using the multistage sampling technique. The data were
collected using a structured, pre-tested self-administered questionnaire. Bivariate and
multivariable logistic regression analyses were employed through SPSS version 25 to
identify factors associated with sexually transmitted infections. Odds ratio with a 95%
confidence interval was computed to determine the level of association. In the multivariable
analysis, variables with p-value less than 5% were considered as statistically significant
association between covariates and sexually transmitted infections.
Result: Sexually transmitted infections among university students were found to be 18.20%
Previous history of sexually transmitted infections (AOR = 2.1; 95%CI: 1.04, 4.38),
multiple sexual partners in life (AOR = 2.7; 95%CI:1.70, 4.40), not use of condoms during
sexual intercourses (AOR = 2.4; 95%CI:1.50,3.75) and poor knowledge of sexually
transmitted infections (AOR = 3.3; 95%CI:1.09,5.32) were significantly associated with
sexually transmitted infections.
Conclusion: The prevalence of STIs was high among university students. The previous
history of sexually transmitted infections, multiple sexual partners, not using condoms
during sexual intercourse and poor knowledge of sexually transmitted infections were found
to be associated with the infections. Opening and strengthen reproductive health centers on
the campuses, popularizing sexual, and reproductive health information and education,
particularly on STI modes of transmission, prevention, and health-seeking behaviours, and
providing information on accessing of condoms is recommended to reduce sexually
transmitted infections.
Keywords: Sexually transmitted infections, University, Students,
1.0 INTRODUCTION STIs facilitate the spread of the human
immunodeficiency virus (HIV) [3]. In
Sexually transmitted infections (STIs) are a
2012, 498.9 and 92.6 million new cases of
variety of clinical syndromes caused by
STIs occurred on the globe and in Africa,
pathogens that can be acquired and
respectively. Thus, on average, about 1.4
transmitted through sexual contact. There
million people are infected with STIs every
are over 30 bacterial, viral, and parasitic
day [4]. In Nigeria, the highest reported
pathogens that have been identified to date
rates of STIs are found among 15–24- year
to be transmitted sexually [1]. Sexually
old, while about half of all of the people
transmitted infections are a major public
infected with HIV and 60% of all new HIV
health problem worldwide that cause of
infections are also in that age group [5].
acute illness, long-term complication,
Because young people are at high risk for
infertility, medical as well as psychological
risky behaviours and low use of preventive
consequences and death [2]. Moreover,
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mechanisms and/or services in developing burden of these infections and identifying

nations, STIs were common sexual and factors among students of higher
reproductive health problems. Adolescents institutions is important for designing an
and young adults catch the highest rates of effective intervention and allocating
curable STIs, and 1 in 20 adolescents resources. Therefore, this study aimed to
acquire new STIs each year [6]. Young assess the prevalence of STIs and its
people, especially those who are unlikely to associated factors among the University of
have access to quality health care services, Port Harcourt regular undergraduate
such as university students are at high risk students.
of STIs [7]. About 80–90% of the global
2.0 METHODS
burden of STIs which found in the
developing world where there is limited 2.1 Study design and setting
and/or no access to diagnostics of STIs [8].
An institution based cross-sectional study
Adolescents and the youth, in general, tend was conducted from October to November
to experiment risky behaviour due to their at the University of Port Harcourt, located
new freedom at boarding institutions, in Rivers state, Nigeria. There was an
liberty from familiarized community, estimate of 32,962 students enrolled in
parents or guardians and teachers in different programs. There is a student’s
secondary schools. University students are clinics and one teaching and referral
categorized under the most at risk hospital providing STI diagnosis and
population segment (MARPS) due to their treatment services to students.
inclination to be engaged in risky sexual
behaviour and their poor sense of 2.2 Sample size and sampling
vulnerability [9–14]. Despite this, youth procedures
have not traditionally been considered a All students attended the University of Port
health priority since they have lower Harcourt in the regular undergraduate
morbidity and mortality rates than older and program during the study period were
younger age groups [15]. The national eligible for the study. The sample size was
HIV/AIDS policy of Nigeria identifies STIs calculated using the single population
prevention and control as one of the proportion formula by considering the
strategies to prevent and control HIV/AIDS prevalence of STIs among university
[16]. Despite the large scale-up of health students as 19.5% [22], a 95% confidence
care investment for the prevention and interval (CI), and a 4% margin of error. By
treatment of STIs in Nigeria [17], the adding a 10% non-response rate and a
prevalence among the Nigerian youth rose design effect of 2, the final sample was 845
from 1.15% in 2015 to 4% in 2021 [18, 19]. students. A multistage sampling technique
This continued increase in the prevalence of was used to select participants. Considering
STIs among the youth may have a 30% rule of thumb and simple random
significant impact on the next fate of the sampling technique with proportional
country since the youth constitute the bulk allocation, 13 departments were selected.
of the future workforce [20]. In spite of the The final samples were selected from the
continued increase in the prevalence of specified departments using the systematic
STIs in the country, relatively little random sampling technique.
epidemiological research has been carried
out on the prevalence and associated risk
factors of STIs [21]. Hence, quantifying the
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2.3 Data collection tool and past 12 months prior to data collection. A
procedures female student was considered as STIs
positive, if she reported one or more of the
Data was collected using a structured self-
following syndromes: abnormal vaginal
administered questionnaire prepared in
discharge, genital ulcer or sores, lower
English. To maintain the privacy of
abdominal pain syndromes in the past 12
participants, seats were arranged far apart.
months prior to data collection. Knowledge
The questionnaire was pre-tested on 42
of STIs was assessed using different
University students outside the study area.
questions which contained having
The data were collected on different
information on STIs, prevention, ways of
variables such as age, sex, religion, marital
transmission, sign and symptoms and
status, ethnicity, religious involvement,
possible complications of STIs. Students
year of study, family residence, monthly
who scored the mean and above in
pocket money, age at first sexual initiation,
knowledge assessment questions were
number of sexual partners, unprotected sex,
considered having good knowledge of
sex with commercial sex workers (CSWs),
STIs. was no significant interaction
knowledge on STIs, substance use,
between independent variables. Adjusted
watch/read, pornography, peer pressure to
Odds Ratio (AOR) with a 95% Confidence
had sex and previous history of STIs. A
Interval (CI) was calculated to determine
male student was considered as STIs
the presence and strength of association. In
positive if he reported one or more of the
the multivariable analysis, a variable with a
following syndromes: a history of Genital
p-value less than 0.05 was considered
ulcer or sores, urethral discharge, scrotal
statistically significant.
swelling, inguinal bubo syndromes in the
3.0 RESULT
Socio-demographic characteristics
A total of 803 university students participated in the study with a response rate of 95%. The
median age of the participants was 21 years (IQR ± of 2 years). Of the participants, 52.9% were
male,91% Christians, and 87.9% were single (Table 1).
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Table 1 Socio-demographic characteristics of the University of Port Harcourt

undergraduate students (n = 803)

Variables Frequency Percentage

Sex
Male 425 52.9
Female 378 47.1
Age
15–19 98 12.2
20–24 675 84.1
25–29 26 3.2
30–34 4 0.5
Marital status
Single 725 90.3
Married 67 8.3
Others 11 1.4
Year of Study
1st Year 194 24.2
2nd Year 190 23.7
3rd Year 242 30.1
4th Year and/or above 177 22
Behavioural characteristics
About 60% of students drank alcohol, 11.6% chewed tobacco, 6.1% smoked shisha, and 75.5%
seen or read pornography (Table 2).
Table 2 Behavioural characteristics of the University of Port Harcourt undergraduate
students (n = 803)

Variables Frequency Percentage

Alcohol drinking
Yes 409 50.9
No 394 49.1
Smoke shisha
Yes 49 6.1
No 754 93.9
Ever watch or read pornographic
materials
Yes 443 55.2
No 360 44.8
Watch/read pornographic
materials in the last 12 months
(n = 443)
Yes 333 75.2
No 110 24.8
Visited night club
Yes 299 37.2
No 504 62.8
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Sexual characteristics
About 61.1% of participants, had ever sex, of which 73.5% had sexual intercourse in the last
12 months. The mean age at first sexual intercourse was 18.8 (SD + 1.9) years. Furthermore,
42.8% of the students started a sexual activity after they joined the University. Of the sexually
active respondents, 23.6% were initiated their first sex before the age of 18 years (Table 3).
Table 3 Sexual characteristics of the University of Port Harcourt undergraduate
students, (n = 803)
Variables Frequency Percentage
Ever had sex (n = 803)
Yes 491 61.1
No 312 38.9
Reason for fist sex (n = 491)
Love 335 68.2
Peer pressure 71 14.5
To get money/benefits 36 7.3
Got married 44 5.5
Other 5 1
First sexual partner (n = 491)
Boy/girlfriend 350 71.3
Teacher 22 4.5
Casual partner 48 9.8
Husband or wife 44 9
Family member 8 1.6
Other 19 3.8
Condom used during first sex (n = 491)
Yes 210 42.8
No 281 57.2
Number of lifetime sexual partners
(n = 491)
One 225 45.8
Two and above 266 54.2
Sex under the influence of Alcohol
(n = 409)
Yes 128 31.3
No 281 68.7
Sex under the influence of Shisha (n = 49)
Yes 8 16.4
No 41 83.6

Knowledge of sexually transmitted infections

Almost all students (98%) were ever heard about STIs. The majority of students (90.4%)
reported that unprotected sex was the major mode of transmission for STIs. Moreover, more
than half (55.3%) of students had good knowledge of STIs.
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Prevalence of sexually transmitted infections

The overall prevalence of sexually transmitted infections at the University of Port Harcourt
was 18.2% (95% CI, 15.4, 20.8) in the past 12 months. About half (46.6%) female students
were known to be infected (Fig. 1). In the last 12 months, genital ulcer and vaginal discharge
were the most prevalent syndromes reported by 43.6 and 55.9% of the male and female students
who had signs and symptoms of STIs, respectively (Fig. 2).

Fig 1: Prevalence of sexually transmitted infections among students in the last

12 months

Fig 2: Syndromes of sexually transmitted infections reported by students

Factors associated with sexually Table 4, peer pressure, viewed or read

transmitted infections Both bivariate and pornographic materials, chewing tobacco,
multivariable logistic regression analyses drinking alcohol, the previous history of
were done to see the effect of the selected STIs, multiple lifetime sexual partners, no
characteristics on STIs. As presented in use of condoms and poor knowledge of
 Page 7 |

STIs were found to have an association with history of STIs. Students who didn’t use
STIs in the bivariate analyses at p-value less condoms had two times more chance of
than lifetime sexual partners, no use of acquiring STIs than those students who had
condoms and poor knowledge of STIs were used (AOR = 2.4; 95% CI: 1.50:3.75).
found to have an association with STIs in Likewise, the odds of developing STIs
the bivariate analyses at p-value less than among students who had two or more
0.2. In the multivariable analyses, previous sexual partners in life were 2.7 times (AOR
history of STIs, multiple lifetime sexual = 2.7; 95% CI:1.70,4.40) higher as
partners, no use condoms and poor compared to those who had a single sexual
knowledge of STIs were significantly partner. Moreover, students who had poor
associated with developing sexually knowledge of STIs were about three times
transmitted infections. The odds of having (AOR = 3.3; 95% CI: 1.09,5.32) higher
STIs were two times higher among students odds of acquiring STIs as compared to the
who had the previous history of STIs (AOR knowledgeable students (Table 4).
= 2.1; 95% CI: 1.04,4.38) compare to no
Table 4 Bivariate and multivariable logistic regression analyses for factors associated
with sexually transmitted infections among the University of Port Harcourt students
Variables Sexually transmitted infections OR (95%CI) aOR (95%CI)
Yes No
Watching/reading pornography
Yes 107 336 2.6 (1.76,4.00) 1.5 (0.93,2.50)
No 39 321 1 1
Peer pressure to had sex
Yes 94 247 3 (2.06,4.36) 1.3 (0.82,2.08)
No 52 410 1 1
Ever had STI (in life)
Yes 25 20 3.36 (1.80,6.27) 2.1 (1.04,4.38) *
No 121 325 1 1
Drink alcohol
Yes 96 313 2.1 (1.45,3.07) 0.85 (0.52,1.40)
No 50 344 1 1
Number of Sexual partners in life
Two and above 100 166 2.3 (1.56,3.50) 2.7 (1.70,4.40) **
One 46 179 1 1
Ever used condom
No 76 125 1.9 (1.3,2.80) 2.4 (1.50,3.75) **
Yes 70 220 1 1
Knowledge of STIS
Poor 103 256 3.75 (2.54,5.50) 3.3 (1.09,5.32) **
Good 43 401 1 1
Note: *(p-value < 0.05) and **(p-value < 0.01)
Page 8 |

4.0 DISCUSSION monitor their children and improve

decision-making capacity on risky health
Identifying of sexually transmitted
behaviours [13, 14].
infections and providing relevant
information, and offering the necessary In this study, 61.1% of the study subjects
health services is a highly effective reported to had sex, of these 54.2% have
intervention in the prevention and control multiple sexual partners in their life. Of the
of STIs. The prevalence of STIs among sexually active study subjects in the
university students in the last 12 months previous year before the survey, 23.6%
was 18.2% (95% CI; 15.4, 20.8%). The were initiated sex before the age of 18 years
finding is comparable with those of studies and 31.3% had sex under the influence of
conducted on the University students in substance. The fact is that risky sexual
Abia (19.5%) [22] and Delta (15.74%) [23]. behaviours such as having multiple sexual
But, this finding was slightly lower than partners, having sex before 18 years old and
those of other studies conducted on sex under the influence of substance can
University of Benin students (28%) [24] expose individuals for the risk of
and female youth at Mekelle (21.3%) [25]. contracting sexually transmitted infections
The possible difference from Mekelle study (STIs) [30]. Large number (75%) of
might be due to the difference in the study students were exposed for pornography.
area and study subjects were selected from Exposing to pornographic materials could
the health facilities where there was a high alter the normal sexual desire and care
probability of finding suspected cases. taking of exposing to sexually transmitted
Furthermore, the possible difference might infections [31, 32]. Having good
be due to the differences in the study knowledge of STIs is one of the protective
subjects. This study included both male and factors for students to be aware of the
female while Mekelle study included modes of transmission, prevention methods
female only. Due to that female’s anatomy and its complications which helps to take
can place at higher risk of sexually care of themselves from STIs. In this study,
transmitted infections than males [26]. The students with poor knowledge of STIs were
finding from this study was higher when more likely to develop STIs than students
compared with the Nigerian Demography with good knowledge.
and Health Survey (EDHS) 2018 report,
This finding agrees with those of other
among the youth (4%) [19], University
studies conducted in Abia state [25],
students (13.9%) [27], Abia state
University of Benin [27], and University of
University students (6.4%) [28] and high
Ilorin [33]. Similarly, having multiple
school students in Edo state (10.7%) [29].
sexual partners is a known risk factor of
The possible difference from the EDHS
sexual and reproductive health. Since
report might be due to that EDHS survey
university students come from different
was a population-based survey which
regions and towns with different cultures
included youth who are living with, and are
and values, they may be vulnerable to
under the control of the family. The data
influences in their new environment as they
collection methods might also account for
live away from family or relatives with new
the variation. Likewise, in the Abia and
friends and classmates. This may limit the
Edo, the variation could be due to the
student’s capability to defend themselves
differences in age and the student’s
from peer pressure. Students could also be
lifestyle. Residing and living with families
easily betrayed by monetary incentives
and relatives helps the parent or relatives to
Page 9 |

from individuals [13, 14]. In this study, mortified or ashamed to report syndromes
students who had two or more sexual (may be subject to social desirability bias).
partners in life were more likely to To minimize the problem, we used a self-
acquiring STIs than a student who had only administered questionnaire and clearly
one sexual partner. This is consistent with informed participants about the purpose of
the various studies conducted at Benson the study and the confidentiality of
Idahosa university [34] and on Malawian information. Sexually transmitted
youth [35]. infections were assessed only through
students reports which approach may miss
Condom use is one of the methods of
asymptomatic students and may
preventing the transmission of STIs [36].
misdiagnose signs/symptoms due to other
Individuals who had never used condoms
problems similar to STIs might be the
were significantly associated with STIs.
possible limitation of the study.
Accordingly, the higher odds of STIs were
observed among students who had never 5.0 CONCLUSION
used condoms during sexual intercourse.
In this study, the prevalence of self-reported
This finding is supported by the previous
STIs in the last 12 months among the
studies in Debre Berhan [24]. This could be
University of Port Harcourt regular
because of individuals who used condoms
undergraduate students was found to be
might have more access, information, and
high as compared to the national figure.
experiences in its appropriate use. Having
Multiple sexual partners in life, previous
the previous history of STIs had a positive
history of STIs, not the use of condoms and
association with the development of STIs,
poor knowledge of STIs were factors
that is, students who previously had STIs
associated with STIs. Therefore,
were more likely to develop STIs than
developing and strengthen reproductive
students with no such history. This finding
health centers on the campuses,
was supported by researches conducted
popularizing sexual and reproductive health
from the United States [37] and Mekelle
information and education, particularly STI
[25]. This might be due to relapse, untreated
modes of transmission, prevention, health-
sexual partner, poor compliance with
seeking behaviours, and providing
treatment, inappropriate treatment, and
information and improving access to
antimicrobial drug resistance. Since sexual
condom is recommended to reduce sexually
behaviour and practice is private, intimate
transmitted infections.
and sensitive, respondents may feel
Ethical considerations departments. The purpose, benefits,
confidentiality of information, and the
Ethical approval was obtained from the
voluntary nature of participation in the
Ethical and Research Committee of the
study were explained and informed consent
University of Port Harcourt. A letter of
was obtained from participants. Any
permission was obtained subsequent
personal identifications were not collected
permission was secured from the respective
from participants during data collection.
 Page 10 |

Competing interests
The authors have declared there is no competing interest.
Author details
1
School of Public Health, University of Port Harcourt, Port Harcourt, Nigeria.
2
Department of Medical Microbiology, College of Health Sciences, University of Port Harcourt, Port Harcourt, Nigeria.
3
Department of Community Medicine, College of Medical sciences, Rivers State University Rivers state, Nigeria

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