Adults who were abused as children may face elevated risk of STDs

Perspectives on Sexual and Reproductive Health, Sept, 2009 by S. Ramashwar

Childhood abuse is linked to an increased risk of STD infection over time, according to findings from a prospective cohort study. (1) Participants who had been sexually abused as children had elevated odds of having had at least one STD (odds ratio, 1.9), and of having had more than one (3.3), by the time they were interviewed as adults. Those who had been physically abused during childhood had higher odds of having been infected with two or more STDs than those who had not been abused (3.6).

Researchers used court records from a metropolitan area in the Midwest to identify children aged 11 or younger between 1967 and 1971 who had been physically abused, sexually abused or neglected. To create a comparison group, they matched these youngsters by gender, race and age with children who had no documented history of abuse. The researchers interviewed respondents in 1989-1995, and again in 2000-2002 and in 2003-2004. For the analysis of the relationship of childhood abuse and neglect and STD risk during adulthood, the researchers used data from face-to-face interviews conducted in 2003-2004, in which respondents were asked about their lifetime STD history.

The 754 respondents in the final sample (423 of whom had been abused or neglected as children and 331 of whom had not) were 41 years old, on average, and about half (53%) were female. Six in 10 had no more than a high school education; 55% had unskilled or semiskilled jobs, and 14% had semiprofessional or professional jobs. Sixty-three percent of participants were white, and 37% were black; respondents of other racial and ethnic groups were excluded because there were too few for analysis.

Some 22% of respondents reported having ever had at least one STD, and 8% reported having had two or more STDs. Similar proportions (3-4%) had had genital herpes, syphilis and human papillomavirus (HPV); 10-12% had had chlamydia or gonorrhea. Black participants were more likely than whites to have had any STD and to have had more than one; therefore, race was controlled for in further analyses. No difference in STD history was found by gender.

Logistic regression analysis revealed that adults who had been abused or neglected did not have an increased likelihood of having had any STDs, but they did have elevated odds of having had two or more STDs (odds ratio, 2.0). The relationship held for those who had experienced physical abuse (3.6) or sexual abuse (3.3), but neglect alone was not related to STD risk. The odds of having had any STD, syphilis or HPV were elevated only for adults who had been sexually abused (1.9, 4.3 and 3.2, respectively); the odds of having had gonorrhea or chlamydia were unrelated to a history of abuse or neglect.

In separate analyses examining STD risk by gender, no associations with childhood abuse and neglect were found among men. However, women who had been sexually abused had higher odds than others of having had multiple STDs (odds ratio, 3.9), syphilis (11.6) or gonorrhea (2.9).

Separate analyses by race also revealed different patterns of associations. Among blacks, a history of childhood sexual abuse was associated with having had syphilis (4.8); no other type of childhood abuse was related to STD risk. In contrast, among whites, those who had experienced any abuse or neglect, sexual abuse or physical abuse had elevated odds of having had multiple STDs (4.2, 3.6 and 5.4, respectively). Whites with a history of sexual abuse also had an increased likelihood of having had any STD (2.6) or gonorrhea (4.0), and those with a history of any abuse had an increased likelihood of having had genital herpes (4.5).

Among other study limitations, the researchers acknowledge that asking about STD history in face-to-face interviews may have led to underreporting, and that respondents were not asked how many times they had been infected. The investigators add that the abuse cases examined were clearly documented, but that respondents in the control group could have experienced unreported abuse. Even so, the researchers note, the findings point to an association between abuse and increased risk of STD infection that continues "beyond adolescence and young adulthood." They encourage greater attention to women and blacks, and early STD screenings for victims of any type of childhood abuse, to help prevent "later health consequences."

REFERENCE

(1.) Wilson HW and Widom CS, Sexually transmitted diseases among adults who had been abused and neglected as children: a 30-year prospective study, American Journal of Public Health, 2009, 99(51): $197-$203.