Health care seeking behaviour of patients attending an STI clinic in Singapore

Abstract

Background: Promoting early health care-seeking behaviour for sexually transmitted infections (STIs) has been recognized as an effective HIV and STI prevention strategy. Understanding the factors influencing these behaviours will help develop more effective interventions.Objective: This study was conducted to assess the patterns of health care-seeking behaviour, STI knowledge, duration of symptoms, and sexual activity during the symptomatic period prior to seeking health care among male patients attending an STI clinic for genitourinary symptoms.Methods: A cross-sectional study was conducted on all new cases of male patients attending the Department of Sexually Transmitted Diseases Control Clinic (DSC) from January 2001 to September 2001. They were interviewed after informed consent, using a structured questionnaire.Results: Of the four hundred patients interviewed, 68% were single and about one-third were non-Singaporeans. The mean age was 32 years (SD: 9.42). Duration of symptoms ranged from 1 day to 650 days with a median of 7 days. Common complaints were dysuria (62.4%) and penile discharge (57%). Slightly more than one-quarter (27%) sought care at a registered clinic after 14 days. Upon noticing symptoms, 11% self-treated and 42.5% awaited resolution. Despite symptoms, 24.5 % of patients continued to have sex. To assess factors associated with the delay in health care-seeking behaviour, patients were divided into those who sought care earlier than 14 days (73%) and those who sought care after 14 days (27%). On univariate analysis, a significantly higher proportion of those who had heard about STI/HIV, had a past history of STI, or had dysuria, genital rash, or genital discharge were more likely to seek care within 14 days. Cox regression analysis, modified for cross-sectional data, was used to assess the independent determinants of delay in health care-seeking behaviour. Being non-Singaporean, those who continued to have sex while symptomatic, those without genital discharge; and those with genital growth or spots were significantly more likely to seek care later than 14 days. Reasons for not seeking care earlier included awaiting spontaneous resolution (65.7%), unawareness of treatment centers (40.7%), and no time off work (32.4%). Perceived possible infection sources were: female sex workers (45.8%), casual partners (21.5%), girlfriends (13.5%), and unknown (19.8%). Common STIs diagnosed in the sample were gonorrhoea (41.3%), non gonococcal urethritis (23.5%), and genital warts (8.5%).Conclusion: A significant proportion (27%) of people showed delay in health care-seeking behaviour for a suspected STI. Interventions focused on STI/HIV prevention should emphasize measures to promote awareness among men to seek early care for STI-related symptoms and to abstain from sex while symptomatic.