Disconnect between STI knowledge and protective behaviors among university students

Background

Sexually transmitted infections (STIs) remain a major public health concern among young adults, with those aged 15-24 accounting for a disproportionate share of infections. Among university students, STI knowledge and preventive behaviours are often inconsistent, yet how this relationship varies across different behavioural risk profiles warrants deeper investigation.

Methods

Cross-sectional survey among students at the University of Verona (Italy, 2020-21). An anonymous questionnaire assessed awareness of STIs and sexual behaviours. Participants were stratified into four risk profiles (minimal, low, medium, high) based on sexual activity, age at sexual debut and number of partners. Multivariable logistic regression examined factors associated with STI awareness and knowledge of preventive methods across behavioural risk profiles, alongside condom use patterns.

Results

A total of 2,187 students participated (mean age 21.9 years; 76.2% female; response rate 9.8%). Only 7.6% were aware of all 11 STIs assessed, with substantial knowledge gaps across specific infections and risk practices. Higher-risk profiles were associated with greater STI awareness (low risk OR 5.04, medium OR 4.50, high OR 4.38; all p ≤ 0.003) and better knowledge of preventive methods (medium OR 1.58, high OR 1.59; both p < 0.03). However, consistent condom use was reported by only 38.9% of sexually active students overall, highest among low-risk students (46.2%) and lowest among those at high risk (27.7%; p < 0.001), and declining from 39.5% among students with one partner to 27.7% among those with three or more (p < 0.001).

Conclusions

Students at greater behavioural risk demonstrated higher STI knowledge yet lower consistent condom use. This disconnect suggests that knowledge alone is insufficient to promote protective behaviours, and that optimistic bias and risk compensation may play a role. Prevention programmes should address behavioural and social determinants beyond knowledge gaps.

Key messages

• Among university students, greater STI knowledge is paradoxically associated with lower consistent condom use, particularly among those at highest behavioral risk.

• Effective STI prevention should address behavioral and social determinants alongside knowledge gaps, moving beyond information provision alone.