Despite current and ongoing prevention efforts, rates of sexually transmitted infections (STIs), including gonorrhea among young people remains high. The majority of the prevention efforts have focused primarily on vaginal intercourse, even though a substantial number of young people are engaging in non-coital activity including oral sex. Although the risk of transmission of STIs is reduced when comparing oral sex to vaginal or anal sex, various studies suggest that oral sex is still a potential transmission route for a number of STIs, including gonorrhea. Because the prevalence of oral sex among young people is relatively high and condom use with this behavior is low the contribution of oral sex to gonorrhea transmission and maintenance of infection among this population may be more important than expected despite the lower transmissibility with oral sex. Testing for pharyngeal gonorrhea among young people is particularly relevant given that the majority of infections are asymptomatic and treatment for pharyngeal infections maybe different from treatments used for urogenital infections. Furthermore, limited data on factors that place young people at increased risk for pharyngeal infections make it unclear what STI prevention interventions should include and how risk reduction messages should be framed. The proposed study will investigate risk factors associated with pharyngeal gonorrhea among young people (i.e., ages 15 - 24) attending public sexually transmitted disease (STD) clinics and identify behaviors that place young people at increased risk for pharyngeal gonorrhea. The formative research will be used to adapt and pilot test an evidence-based STI prevention intervention (Project SAFE) in order to reduce risky behaviors that place young people at increased risk for STIs, including pharyngeal gonorrhea. The study described in this award application is the first example of research designed to broaden the applicability of an already proven, evidence-based intervention for STI prevention by inclusion of messages surrounding oral sex. This award application is intended to support the applicant's Mentored Research Scientist Development Award (K01) through mentoring, formal training in health related behavior change, behavioral prevention methods, and interventions to reduce STI transmission. The long-term goals of this research project are to provide the foundation for STI prevention research. At the end of the award period, the applicant will submit a R01 or R34 proposal to evaluate the new intervention in an appropriately powered randomized trial. This will be the center the applicant's research agenda for the next decade - to become an independent investigator conducting prevention interventions that reduce STIs among populations at high risk, namely young people.
Gonorrhea is the second most common reported disease in the United States, with the highest reported rates among those 15 - 24 years of age. Although there has been a considerable amount of effort aimed at prevention and intervention efforts to reduce risky sexual behaviors among adolescents and young adults, rates of sexually transmitted infections, including gonorrhea remain high among this group. Behavioral prevention strategies, grounded in theory and adapted based on culturally, contextually, and epidemiologically relevant research could have an impact on rates of gonorrhea infection among young people.
