Sexually Transmitted Diseases (STDs) continue to pose a significant public health challenge worldwide, affecting individuals, families and communities. In Shimla, a region of scenic beauty nestled in the Himalayan foothills of Himachal Pradesh, India, the need to address and mitigate the impact of STDs is paramount. Ensuring the sexual health and well-being of the population in Shimla is not only a local concern but also contributes to broader efforts in reducing the global burden of STDs [1-3].

STDs, often caused by bacterial, viral or parasitic infections, are a group of infections that are primarily transmitted through sexual contact. These diseases encompass a wide range of conditions, including but not limited to, human immunodeficiency virus (HIV), syphilis, gonorrhea, chlamydia and genital herpes. Left untreated, STDs can lead to severe health complications, including infertility, chronic pain and an increased risk of HIV transmission. The consequences of STDs extend beyond physical health, impacting mental and social well-being and straining healthcare systems and economies [4-6].

Understanding the levels of awareness and knowledge about STDs among the general population is a crucial step in tackling the spread of these diseases in Shimla. A comprehensive assessment of the current awareness levels and knowledge gaps is necessary to develop targeted prevention strategies, education programs and accessible healthcare services.

Globally, STDs remain a major public health concern. The World Health Organization (WHO) reports that more than one million new cases of sexually transmitted infections (STIs) are acquired each day, highlighting the urgency of addressing this issue (WHO, 2021). In India, the prevalence of STDs varies across regions, with a significant burden in some states. Given the diverse culture and demographics in Himachal Pradesh, understanding the specific context in Shimla is essential for tailoring interventions [7,8].

This study aims to shed light on the awareness and knowledge levels of STDs within the local community of Shimla. By assessing the current understanding, misconceptions and areas requiring attention, this research seeks to provide valuable insights for healthcare professionals, policymakers and organizations working to combat STDs. Furthermore, this study aligns with the broader goals of promoting sexual health, reducing disease transmission and enhancing the overall quality of life for Shimla's residents.

STD prevention and control require a multifaceted approach that includes education, testing, counseling and access to treatment. The first step in this process is to gauge the existing knowledge base and awareness levels within the community. This study endeavors to contribute to the efforts in Shimla to ensure safe love and healthy lives for its residents.

Objectives of the Study

The objective of this study is to gauge the levels of awareness and knowledge about Sexually Transmitted Diseases among the general population of Shimla.

• Research Approach:   Descriptive

• Research Design:        Cross-sectional survey design

• Study area:                                   District Shimla, Himachal Pradesh

• Study duration:                           Between April 2023 to June 2023

Study Population

The study's target population encompassed all adults aged 18 and above who had been residents of District Shimla for a minimum of 12 months

Sample Size

A robust sample size of 400 adults was determined using a 95% confidence level, an estimated knowledge level of 50% regarding Sexually Transmitted Diseases, a precise 5% absolute error margin and a conservative 5% non-response rate. 

Study Tool

A google form questionnaire consisting of questions regarding socio-demography and knowledge regarding Sexually Transmitted Diseases was created. The questionnaire was initially pre-tested on a small number of participants to identify any difficulty in understanding by the respondents. 

Description of Tool 

Demographic Data Survey Instrument: The demographic form elicited information on participants’ background, age, marital status, religion, employment, education and many more.

Questionnaire

The questionnaire contains 20 structured knowledge related questions regarding Sexually Transmitted Diseases. One mark was given for each correct answer and zero for incorrect answer. The maximum score was 20 and minimum score was zero. Scoring was done on the basis of marks as >80% (16-20) = very good, 60-79% (12-15) = Good, 41-59% (8-11) = Fair, <40% (< 8) = poor.

Validity of Tool

Validity of the tool was tested by the experts in this field.

Data Collection

Data was collected under the guidance of supervisors. The google form questionnaire was circulated among the residents of District Shimla, Himachal Pradesh for responses using online modes like e-mail and social media platforms like WhatsApp groups, Facebook, Instagram and LinkedIn till the 400 responses were collected. 

Data Analysis

Data was collected and entered in Microsoft excel spread sheet, cleaned for errors and analyzed with Epi Info V7 Software with appropriate statistical test in terms of frequencies and percentage. 

The primary objective of this study was to gauge the understanding of Sexually Transmitted Diseases among the general population of Shimla. A total of 400 participants took part in the study, with 267 (66.75%) residing in urban areas and 133 (33.25%) in rural areas.

In the present study 26.5% (106) participants had very good knowledge (16-20 marks) towards Sexually Transmitted Diseases, 36.25% (145) had good knowledge (12-15 marks), 19.5% (78) had fair knowledge (8-11 marks) and 17.75% (71) having poor knowledge (<8 marks).

Table 1: Knowledge regarding Sexually Transmitted Diseases among study participants

Figure 1: Knowledge scores towards Sexually Transmitted Diseases among study participants

Sexually Transmitted Diseases (STDs) remain a global public health challenge, necessitating comprehensive efforts to mitigate their impact. The discussion below delves into the findings of this study, which aimed to assess the awareness and knowledge levels regarding STDs among the general population of Shimla, Himachal Pradesh. The study involved 400 participants, with 66.75% residing in urban areas and 33.25% in rural areas.

A significant portion of the respondents, 82.25%, correctly understood what STDs are and how they are caused. This foundational knowledge is crucial for recognizing the risks associated with sexual contact and the importance of sexual health. Approximately 71.75% of participants could name at least three common types of STDs. This indicates a reasonable level of awareness, as recognizing specific STDs is essential for prevention and early diagnosis.

In our study, 66.25% of respondents correctly identified how STDs are primarily transmitted from person to person. This knowledge is vital in adopting preventive measures, such as safe sexual practices. 65.25% recognized common risk factors associated with contracting STDs. Identifying these risk factors is pivotal in raising awareness and promoting safer sexual behaviors.

An encouraging 70.5% of participants knew that STDs cannot be spread through casual contact like hugging or sharing food. This knowledge helps dispel misconceptions and reduce stigma associated with STDs. 60.25% correctly identified the typical clinical features or symptoms of common STDs. Recognizing these symptoms can lead to early diagnosis, treatment and prevention of complications.

A noteworthy 71.75% recognized the importance of addressing STDs promptly. This awareness highlights the significance of early intervention in mitigating the severity of these diseases. 60.75% were aware of the potential complications of untreated STDs. Understanding the consequences underscores the importance of prevention and timely treatment. 65.25% could explain the importance of safe sex practices in preventing STDs. This knowledge is crucial for promoting responsible sexual behavior. 59.5% recognized the existence of specific preventive measures individuals can take to reduce their risk of STDs. This awareness is vital in encouraging proactive sexual health practices.

In the present study, 33% of participants could name government-sponsored sexual health programs or schemes in their country. Awareness of such programs can facilitate access to sexual health services. 44% knew what someone should do if they suspect they have an STD or have had unprotected sex with a partner who has one. This knowledge promotes responsible actions and healthcare seeking. 28% could describe the standard treatment options for common STDs. While this percentage is lower, it underscores the need for education about treatment modalities. 24.5% were aware of antibiotic-resistant strains of STDs and how they are treated. This awareness highlights the emerging issue of antimicrobial resistance in STDs.

In our study, 25.5% recognized the role of routine STD screening in sexual health maintenance. Increased awareness in this area could encourage regular testing. 32.25% could name public health campaigns or initiatives related to STD awareness and prevention. Enhancing awareness of such campaigns can further promote sexual health. 54.75% recognized the role of individuals and communities in raising awareness about safe sex practices and STDs. This acknowledgment reflects a willingness to actively participate in sexual health initiatives. 36.75% were aware of misconceptions or myths about STDs. Addressing these misconceptions through education are essential in promoting accurate knowledge. 32% could describe the importance of partner notification and contact tracing in STD prevention. This understanding is pivotal in reducing transmission rates.

Comparing these findings with studies conducted in various regions, Shimla's residents demonstrate a reasonable level of awareness and knowledge regarding STDs [9-15]. Several aspects, such as understanding the importance of addressing STDs promptly, align with findings from other studies. However, knowledge gaps exist in areas like recognizing specific government-sponsored programs and treatment options for STDs.

This study provides valuable insights into the levels of awareness and knowledge regarding STDs among the general population of Shimla. While there is a foundation of awareness in many areas, there are notable knowledge gaps that could be addressed through targeted education and awareness campaigns. Enhancing sexual health knowledge in Shimla is not only essential for the well-being of its residents but also contributes to global efforts to reduce the burden of STDs.

Ethical Approval

Ethical Considerations: Participants’ confidentiality and anonymity were maintained.

1. World World Health Organization. Sexually Transmitted Infections (STIs). 2021. https://www.who.int/news-room/fact-sheets/detail/sexually-transmitted-infections-(stis).

2. Centers for Disease Control and Prevention. Sexually Transmitted Diseases (STDs). 2021. https://www.cdc.gov/ std/default.htm.

3. Unemo, M. and C.S. Bradshaw. “Hologic Global Challenge to Prevent Antimicrobial Resistance in Neisseria gonorrhoeae: Development and Global Application of the Hologic Global Point-of-Care Assay and Epidemiological and Diagnostic Implications.” Sexually Transmitted Infections, vol. 95, suppl. 1, 2019, pp. A3–A4.

4. Tucker, J.D. et al. “Scaling Up Syphilis Testing in China: Implementation Beyond the Clinic.” Bulletin of the World Health Organization, vol. 95, no. 8, 2017, p. 549.

5. Janier, M. et al. “2014 European Guideline on the Management of Syphilis.” Journal of the European Academy of Dermatology and Venereology, vol. 33, no. 8, 2019, pp. 1435–1446.

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7. Korenromp, E.L. et al. “Global Burden of Maternal and Congenital Syphilis and Associated Adverse Birth Outcomes—Estimates for 2016 and Progress Since 2012.” PLoS One, vol. 14, no. 2, 2019.

8. Gottlieb, S.L. et al. “The Global Roadmap for Advancing Development of Vaccines Against Sexually Transmitted Infections: Update and Next Steps.” Vaccine, vol. 38, no. 32, 2020, pp. 5037–5043.

9. World Health Organization. Report on Global Sexually Transmitted Infection Surveillance 2015. 2016.

10. Wi, T. et al. “Antimicrobial Resistance in Neisseria gonorrhoeae: Global Surveillance and a Call for International Collaborative Action.” PLoS Medicine, vol. 14, no. 7, 2017.

11. Korenromp, E.L. et al. “Global Burden of Maternal and Congenital Syphilis and Associated Adverse Birth Outcomes—Estimates for 2016 and Progress Since 2012.” PLoS One, vol. 14, no. 2, 2019.

12. Gottlieb, S.L. et al. “The Global Roadmap for Advancing Development of Vaccines Against Sexually Transmitted Infections: Update and Next Steps.” Vaccine, vol. 38, no. 32, 2020, pp. 5037–5043.

13. Unemo, M. and C.S. Bradshaw. “Hologic Global Challenge to Prevent Antimicrobial Resistance in Neisseria gonorrhoeae: Development and Global Application of the Hologic Global Point-of-Care Assay and Epidemiological and Diagnostic Implications.” Sexually Transmitted Infections, vol. 95, suppl. 1, 2019, pp. A3–A4.

14. Tucker, J.D. et al. “Scaling Up Syphilis Testing in China: Implementation Beyond the Clinic.” Bulletin of the World Health Organization, vol. 95, no. 8, 2017, p. 549.

15. Janier, M. et al. “2014 European Guideline on the Management of Syphilis.” Journal of the European Academy of Dermatology and Venereology, vol. 33, no. 8, 2019, pp. 1435–1446.