Objectives: The aims of this study were to identify partner attributes associated with sexually transmitted infections (STIs) among adolescents and to summarize implications for research and prevention.
Design: The design of this study was systematic review.
Methods: We identified peer-reviewed studies published in 1990 through 2010 that assessed 1 or more partner attributes in relation to a biologically confirmed STI among adolescents (15–24 years) by searching MEDLINE and included articles. Studies that included adolescents but more than 50% of the sample or with mean or median age of 25 years or greater were excluded.
Results: Sixty-four studies met the eligibility criteria; 61% were conducted in high-income countries; 80% were cross sectional; and 91% enrolled females and 42% enrolled males. There was no standard “partner” definition. Partner attributes assessed most frequently included the following: age, race/ethnicity, multiple sex partners, and STI symptoms. Older partners were associated with prevalent STIs but largely unrelated to incidence. Black race was associated with STIs but not uniformly. Partners with multiple partners and STI symptoms seem to be associated with STIs predominantly among females. Although significant associations were reported, weaker evidence exists for the following: other partner sociodemographics, sexual and other behaviors (sexual concurrency, intimate partner violence, substance use, travel), and STI history. There were no apparent differences by STI.
Conclusions: Partner attributes are independently associated with STIs among male and female adolescents worldwide. These findings reinforce the importance of assessing partner attributes when determining STI risk. Prevention efforts should continue to promote and address barriers to condom use. Increased efforts are needed to screen and treat STIs and reduce risky behavior among men. A standard partner definition would facilitate the interpretation of findings in future studies.
Partner attributes are independently associated with sexually transmitted infections among male and female adolescents worldwide but may be more important determinants of sexually transmitted infection risk for girls. Supplemental Digital Content is available in the article.
From the *Emory University Rollins School of Public Health, Atlanta, GA; †Johns Hopkins School of Medicine, Baltimore, MD; and ‡Yale School of Public Health, New Haven, CT
Conflicts of interest and financial disclosures: None reported.
Funding statement: Andrea Swartzendruber was supported by National Institute on Alcohol Abuse and Alcoholism Grant No. F32AA022058. Jennifer L. Brown was supported by National Institute of General Medical Sciences Grant No. K12 GM000680. Jessica M. Sales was supported by National Institute of Mental Health Grant No. K01 MH085506.
Contributorship statement: Jonathan M. Zenilman and Jessica M. Sales contributed substantially to conception and design and revised the manuscript critically for important intellectual content. Linda M. Niccolai, Trace S. Kershaw, Jennifer L. Brown, and Ralph J. DiClemente revised the manuscript critically for important intellectual content.
Correspondence: Andrea Swartzendruber, PhD, MPH, Emory University Rollins School of Public, Health, 1518 Clifton Rd, Atlanta, GA. E-mail: firstname.lastname@example.org.
Received for publication August 3, 2012, and accepted December 18, 2012.
Supplemental digital content is available for this article. Direct URL citations appear in the printed text, and links to the digital files are provided in the HTML text of this article on the journal’s Web site (http://www.stdjournal.com).