{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,25]],"date-time":"2026-10-25T00:15:57Z","timestamp":1792887357603,"version":"4.5.0"},"reference-count":44,"publisher":"MDPI AG","issue":"2","license":[{"start":{"date-parts":[[2022,1,14]],"date-time":"2022-01-14T00:00:00Z","timestamp":1642118400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["IJERPH"],"abstract":"<jats:p>Background. The peak of sexually transmitted infections (STI) among adolescents\/young adults suggests a low level of prevention. In order to assess whether the level of sexual health education (SHE), received by several channels, was effective at improving sexual behaviors, we conducted a survey among freshmen from four Italian universities. Methods. This observational cross-sectional study was carried out with an anonymous self-reported paper questionnaire, administered during teaching lectures to university freshmen of the northern (Padua, Bergamo, and Milan campuses) and southern (Palermo campus) parts of the country. Knowledge of STI (a linear numerical score), knowledge of STI prevention (dichotomous variable: yes vs. no) and previous STI occurrence (polytomous variable: \u201cno\u201d; \u201cdon\u2019t know\u201d; \u201cyes\u201d) were the outcomes in the statistical analysis. Results. The final number of freshmen surveyed was 4552 (97.9% response rate). The mean age of respondents was 21.4 \u00b1 2.2 years and most of them (70.3%) were females. A total of 60% of students were in a stable romantic relationship. Only 28% respondents knew the most effective methods to prevent STI (i.e., condom and sexual abstinence), with a slightly higher prevalence of correct answers among females (31.3%) than males (25.8%). Students with history of STIs were 5.1%; they reported referring mostly to their general practitioner (GP) (38.1%) rather than discussing the problem with their partner (13.1%). At multivariable analysis, a significantly higher level of STI knowledge was observed in older students (25+ years of age), biomedical students, and those from a non-nuclear family; lower levels were found among students of the University of Palermo, and those who completed a vocational secondary school education. Those who had less knowledge about the most effective tools to prevent STIs included males, students from the University of Palermo, students registered with educational sciences, economics\/political sciences, those of foreign nationality, and those whose fathers had lower educational levels. The risk of contracting a STI was significantly lower only in students not in a stable relationship (relative risk ratio, RRR = 0.67; 95% confidence interval, 95%CI = 0.48; 0.94), whereas such risk was significantly higher in students with higher STI knowledge (RRR = 1.15; 95%CI = 1.08; 1.22). Discussion and Conclusions. University freshmen investigated in this study had poor knowledge of STIs and their prevention. Unexpectedly, those with higher levels of knowledge had an increased risk of STIs. There have been no educational interventions\u2014with good quality and long-term follow-ups\u2014that increased the confidence that such SHE programs could have population level effects. A new high-quality study is therefore recommended to assess the effectiveness of an intervention generating behavioral changes; increasing only STI knowledge may not be sufficient.<\/jats:p>","DOI":"10.3390\/ijerph19020897","type":"journal-article","created":{"date-parts":[[2022,1,14]],"date-time":"2022-01-14T03:14:56Z","timestamp":1642130096000},"page":"897","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":28,"title":["A Survey on Knowledge, Prevention, and Occurrence of Sexually Transmitted Infections among Freshmen from Four Italian Universities"],"prefix":"10.3390","volume":"19","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-6285-7355","authenticated-orcid":false,"given":"Luca","family":"Cegolon","sequence":"first","affiliation":[{"name":"Occupational Medicine Unit, Department of Medical, Surgical & Health Sciences, University of Trieste, 34129 Trieste, Italy"},{"name":"Public Health Department, University Health Agency Giuliano-Isontina (ASUGI), 34128 Trieste, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Melania","family":"Bortolotto","sequence":"additional","affiliation":[{"name":"FISPPA Department, Padua University, 35137 Padua, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4119-0803","authenticated-orcid":false,"given":"Saverio","family":"Bellizzi","sequence":"additional","affiliation":[{"name":"Independent Researcher, 1200 Geneva, Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Andrea","family":"Cegolon","sequence":"additional","affiliation":[{"name":"Department of Political, Social & International Relationships Sciences, University of Macerata, 62100 Macerata, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7022-4083","authenticated-orcid":false,"given":"Luciano","family":"Bubbico","sequence":"additional","affiliation":[{"name":"Department of Sensorineural Disabilities, INAPP\/Italian Institute of Social Medicine, 00198 Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9956-6693","authenticated-orcid":false,"given":"Giuseppe","family":"Pichierri","sequence":"additional","affiliation":[{"name":"Microbiology Department, Kingston Hospital NHS Foundation Trust, Kingston upon Thames KT2 7QB, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Giuseppe","family":"Mastrangelo","sequence":"additional","affiliation":[{"name":"Department of Cardiac, Thoracic, Vascular Sciences & Public Health, Padua University, 35128 Padua, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Carla","family":"Xodo","sequence":"additional","affiliation":[{"name":"FISPPA Department, Padua University, 35137 Padua, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2022,1,14]]},"reference":[{"key":"ref_1","first-page":"785","article-title":"Sex Ed by Brown Med: A Student-Run Curriculum and Its Impact on Sexual Health Knowledge","volume":"49","author":"Duh","year":"2017","journal-title":"Fam. Med."},{"key":"ref_2","doi-asserted-by":"crossref","unstructured":"Panatto, D., Amicizia, D., Trucchi, C., Casabona, F., Lai, P.L., Bonanni, P., Boccalini, S., Bechini, A., Tiscione, E., and Zotti, C.M. (2012). Sexual behaviour and risk factors for the acquisition of human papillomavirus infections in young people in Italy: Suggestions for future vaccination policies. BMC Public Health, 12.","DOI":"10.1186\/1471-2458-12-623"},{"key":"ref_3","unstructured":"World Health Organization (2018). Report on Global Sexually Transmitted Infection Surveillance, World Health Organization. Available online: https:\/\/www.who.int\/reproductivehealth\/publications\/stis-surveillance-2018\/en\/."},{"key":"ref_4","unstructured":"World Health Organization (2021, June 16). Sexually Transmitted Infections (STI). Available online: http:\/\/www.who.int\/topics\/sexually_transmitted_infections\/en\/."},{"key":"ref_5","unstructured":"Centre for Disease Control and Prevention (CDC) (2021, June 16). Adolescents and Young Adults, Available online: https:\/\/www.cdc.gov\/std\/life-stages-populations\/adolescents-youngadults.htm."},{"key":"ref_6","unstructured":"Istituto Superiore di Sanit\u00e0 (Notiziario) (2021, June 16). Le Infezioni Sessualmente Trasmesse: Aggiornamento Dei Dati Dei Due Sistemi Di Sorveglianza Sentinella Attivi in Italia Al 31 Dicembre 2018. Available online: https:\/\/www.epicentro.iss.it\/ist\/pdf\/notiziario-dati-2018.pdf."},{"key":"ref_7","unstructured":"WHO Regional Office for Europe and BZgA (2010) (2021, November 16). Standards for Sexuality Education in Europe\u2014A Framework for Policy Makers, Educational and Health Authorities and Specialists. Available online: https:\/\/www.icmec.org\/wp-content\/uploads\/2016\/06\/WHOStandards-for-Sexuality-Ed-in-Europe.pdf."},{"key":"ref_8","first-page":"E84","article-title":"Knowledge of sexually transmitted infections and risky behaviours: A survey among high school and university students","volume":"60","author":"Visalli","year":"2019","journal-title":"J. Prev. Med. Hyg."},{"key":"ref_9","unstructured":"Barnekow, V., Buijs, G., Clift, S., Jensen, B.B., Paulus, P., Rivett, D., and Young, I. (2021, June 15). Health-Promoting Schools: A Resource for Developing Indicators. Available online: https:\/\/apps.who.int\/iris\/bitstream\/handle\/10665\/107805\/E89735.pdf;jsessionid=4BC9106BFE9526781F340DF3BD8BAFEA?sequence=1."},{"key":"ref_10","unstructured":"UNESCO (2021, June 16). International Technical Guidance on Sexuality Education. An Evidence-Informed Approach. Available online: https:\/\/www.who.int\/reproductivehealth\/publications\/adolescence\/comprehensive-sexuality-education\/en\/."},{"key":"ref_11","unstructured":"Treaty, L. (2022, January 04). Consolidated version of the Treaty on the Functioning of the European Union, Title XIV \u2018Public Health\u2019, Article 168. Available online: http:\/\/eurlex.europa.eu\/LexUriServ\/LexUriServ.do?uri=OJ:C:2010:083:0047:0200:en:PDF."},{"key":"ref_12","unstructured":"European Parliament\u2014Directorate General for European Policies (2021, June 16). Policies for Sexuality Education in the European Union. Available online: https:\/\/op.europa.eu\/en\/publication-detail\/-\/publication\/17522867-38aa-4ec5-b5b4-711d96f7b900."},{"key":"ref_13","doi-asserted-by":"crossref","unstructured":"Kundisova, L., Nante, N., Lorenzini, C., Valeri, V., Messina, G., and Alaimo, L. (2019). Italian adolescents and sexual health: What has changed during the last 20 years?. Eur. J. Public Health, 29.","DOI":"10.1093\/eurpub\/ckz185.025"},{"key":"ref_14","unstructured":"UK Department of Education (2021, June 01). Statutory Guidance Relationships Education (Primary), Available online: https:\/\/www.gov.uk\/government\/publications\/relationships-education-relationships-and-sex-education-rse-and-health-education\/relationships-education-primary."},{"key":"ref_15","unstructured":"IPPF, and BZgA (2018). Sexuality Education in Europe and Central Asia. State of the Art and Recent Developments. An Overview of 25 Countries, IPFF European Network. Available online: http:\/\/www.euro.who.int\/__data\/assets\/pdf_file\/0010\/379054\/BZgA_IPPFEN_ComprehensiveStudyReport_Online.pdf?ua=1."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"33","DOI":"10.1080\/17437199.2016.1240625","article-title":"A comprehensive review of reviews of school-based interventions to improve sexual-health","volume":"11","author":"Denford","year":"2017","journal-title":"Health Psychol. Rev."},{"key":"ref_17","first-page":"CD009927","article-title":"Individual-, family-, and school-level interventions targeting multiple risk behaviours in young people","volume":"10","author":"MacArthur","year":"2018","journal-title":"Cochrane Database Syst. Rev."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"91","DOI":"10.1363\/psrh.12102","article-title":"Effects of Interventions Addressing School Environments or Educational Assets on Adolescent Sexual Health: Systematic Review and Meta-analysis","volume":"51","author":"Peterson","year":"2019","journal-title":"Perspect. Sex. Reprod. Health"},{"key":"ref_19","unstructured":"Henry, J., and Kaiser Family Foundation (2021, November 01). National Survey of Adolescents and Young Adults: Sexual Health Knowledge, Attitudes and Experiences. Available online: https:\/\/www.kff.org\/wp-content\/uploads\/2013\/01\/national-survey-of-adolescents-and-young-adults.pdf."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"16466","DOI":"10.1038\/s41598-020-72200-6","article-title":"Birth Control Knowledge among Freshmen of Four Italian Universities","volume":"10","author":"Cegolon","year":"2020","journal-title":"Sci. Rep."},{"key":"ref_21","first-page":"40","article-title":"Knowledge of sexually transmitted infections and sex-at-risk among Italian students of health professions. Data from a one-month survey","volume":"54","author":"Santangelo","year":"2018","journal-title":"Ann. Ist. Super. Sanit\u00e0"},{"key":"ref_22","first-page":"25","article-title":"Sexual Behaviors, Attitudes, and Knowledge about Sexually Transmitted Infections: A Cross-sectional Study in Romania","volume":"26","author":"Grad","year":"2018","journal-title":"Acta Derm. Croat."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"1550","DOI":"10.1016\/S0140-6736(06)69485-3","article-title":"Putting sexual and reproductive health on the agenda","volume":"368","author":"Glasier","year":"2006","journal-title":"Lancet"},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"29","DOI":"10.1023\/A:1018713231400","article-title":"Sexual behavior and AIDS related knowledge among community college students in Orange County, California","volume":"24","author":"Shapiro","year":"1999","journal-title":"J. Commun. Health"},{"key":"ref_25","doi-asserted-by":"crossref","unstructured":"Samkange-Zeeb, F.N., Spallek, L., and Zeeb, H. (2011). Awareness and knowledge of sexually transmitted diseases (STDs) among school-going adolescents in Europe: A systematic review of published literature. BMC Public Health, 11.","DOI":"10.1186\/1471-2458-11-727"},{"key":"ref_26","unstructured":"Public Health England (2021, October 06). Sex Trans Infect (STIs): Annual Data Tables, Available online: https:\/\/www.gov.uk\/government\/uploads\/system\/uploads\/attachment_data\/file\/559993\/hpr2216_stis_CRRCTD4.pdf."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"47","DOI":"10.1007\/5584_2015_5015","article-title":"Prevalence of Chlamydia trachomatis, Trichomonas vaginalis and Neisseria gonorrhoeae based on data collected by a network of clinic microbiology laboratories, in Italy","volume":"901","author":"Salfa","year":"2016","journal-title":"Adv. Exp. Med. Biol."},{"key":"ref_28","unstructured":"ECDC (2022, January 04). Chlamydia Infection. Annual Epidemiological Report for 2018. Available online: https:\/\/www.ecdc.europa.eu\/en\/publications-data\/chlamydia-infection-annual-epidemiological-report-2018."},{"key":"ref_29","unstructured":"Rieder, H.L. (1999). Epidemiologic Basis of Tuberculosis Control, International Union against Tuberculosis and Lung Diseases. [1st ed.]. Available online: https:\/\/www.theunion.org\/what-we-do\/publications\/french\/pub_epidemiologic_basis_fre.pdf."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"227","DOI":"10.1080\/14681810903059060","article-title":"Sexuality Education in Europe: An Overview of Current Policies","volume":"9","author":"Parker","year":"2009","journal-title":"Sex Educ."},{"key":"ref_31","doi-asserted-by":"crossref","unstructured":"Drago, F., Ciccarese, G., Zangrillo, F., Gasparini, G., Cogorno, L., Riva, S., Javor, S., Cozzani, E., Broccolo, F., and Esposito, S. (2016). Survey of Current Knowledge on Sexually Transmitted Diseases and Sexual Behaviour in Italian Adolescents. Int. J. Environ. Res. Public Health, 13.","DOI":"10.3390\/ijerph13040422"},{"key":"ref_32","first-page":"E3","article-title":"Knowledge of sexually transmitted infections and risky behaviors among undergraduate students in Tirana, Albania: Comparison with Italian students","volume":"61","author":"Ciccarese","year":"2020","journal-title":"J. Prev. Med. Hyg."},{"key":"ref_33","first-page":"114","article-title":"Risk perception of sexually transmitted diseases and teenage sexual behaviour: Attitudes towards in a sample of Italian adolescents","volume":"54","author":"Bergamini","year":"2013","journal-title":"J. Prev. Med. Hyg."},{"key":"ref_34","first-page":"E76","article-title":"Impact of training conferences on high-school students\u2019 knowledge of sexually transmitted infections (STIs)","volume":"60","author":"Orlando","year":"2019","journal-title":"J. Prev. Med. Hyg."},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"1504","DOI":"10.1080\/21645515.2016.1156271","article-title":"Human papillomavirus infection and vaccination: Knowledge and attitudes among young males in Italy","volume":"12","author":"Napolitano","year":"2016","journal-title":"J. Hum. Vaccines Immunother."},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"97","DOI":"10.1016\/j.srhc.2016.11.004","article-title":"Sexual and reproductive health in Spanish University Students. A comparison between medical and law students","volume":"11","author":"Coronado","year":"2017","journal-title":"Sex. Reprod. Health"},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"21","DOI":"10.1363\/43e3217","article-title":"Awareness of and knowledge about STIs among nonmedical students in Iran","volume":"43","author":"Karamouzian","year":"2017","journal-title":"Int. Perspect. Sex. Reprod. Health"},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"891","DOI":"10.1136\/bmj.328.7444.891","article-title":"Partner reduction is crucial for balanced \u201cABC\u201d approach to HIV prevention","volume":"328","author":"Shelton","year":"2004","journal-title":"BMJ"},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"2171","DOI":"10.1097\/00002030-200111090-00013","article-title":"HIV incidence and sexually transmitted disease prevalence associated with condom use: A population study in Rakai, Uganda","volume":"15","author":"Ahmed","year":"2001","journal-title":"AIDS"},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"39","DOI":"10.1111\/j.1728-4465.2004.00004.x","article-title":"Condoms for AIDS Prevention in the Developing World: A Review of the Scientific Literature","volume":"35","author":"Hearst","year":"2004","journal-title":"Stud. Fam. Plan."},{"key":"ref_41","doi-asserted-by":"crossref","first-page":"1","DOI":"10.3310\/hta14300","article-title":"School-linked sexual health services for young people (SSHYP): A survey and systematic review concerning current models, effectiveness, cost-effectiveness and research opportunities","volume":"14","author":"Owen","year":"2010","journal-title":"Health Technol. Assess."},{"key":"ref_42","unstructured":"European Union Agency for Sexual Services (2021, June 16). Accessing Reproductive or Sexual Health Services. Available online: https:\/\/fra.europa.eu\/en\/publication\/2017\/mapping-minimum-age-requirements\/sexual-health-services."},{"key":"ref_43","unstructured":"National Health Service (2021, June 16). What Services Do Sexual Health Clinics (GUM Clinics) Provide?. Available online: https:\/\/www.nhs.uk\/common-health-questions\/sexual-health\/what-services-do-sexual-health-clinics-gum-clinics-provide\/."},{"key":"ref_44","doi-asserted-by":"crossref","first-page":"351","DOI":"10.3109\/13625187.2012.696751","article-title":"Youth sexual health improvement in Estonia, 1990\u20132009: The role of sexuality education and youth-friendly services","volume":"17","author":"Haldre","year":"2012","journal-title":"Eur. J. Contracept. Reprod. Health Care"}],"container-title":["International Journal of Environmental Research and Public Health"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/1660-4601\/19\/2\/897\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,13]],"date-time":"2025-10-13T13:39:42Z","timestamp":1760362782000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/1660-4601\/19\/2\/897"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2022,1,14]]},"references-count":44,"journal-issue":{"issue":"2","published-online":{"date-parts":[[2022,1]]}},"alternative-id":["ijerph19020897"],"URL":"https:\/\/doi.org\/10.3390\/ijerph19020897","relation":{},"ISSN":["1660-4601"],"issn-type":[{"value":"1660-4601","type":"electronic"}],"subject":[],"published":{"date-parts":[[2022,1,14]]}}}