Article

Perception of undergraduate university

students towards sexually transmitted diseases:
A qualitative study
Keywords Redhwan Ahmed Al-Naggar and Karim Al-Jashamy
STDs
Abstract
University students
Background: University students as young adult population are reportedly at higher risk for HIV infection than the general
Qualitative population. The objective of this study was to explore the perceptions of undergraduate university students towards the
sexual transmitted diseases (STDs).
Methods: An in-depth interview was conducted among 26 university students. The participants were selected randomly
from their respective faculty.
Results: Most of the participants (73%) heard about the STDs. The majority of the participants (65%) also knew about the
causes of STDs. Less than half of the participants (46%) considered the sexual intercourse as the common mode of the
transmission of STDs. Multiple sex partners and prostitute as the most risk at groups were respectively mentioned by 27%
and 15% of the participants. More than half (57.7%) and less than half (42.3%) of the participants respectively mentioned
practice of safe sex by using condom and public education as preventive measures of STDs infection.
Conclusions: Most of the participants heard about STDs, knew about the causes and some of the preventive measures.
However, more than half of the participants did not know about the mode of the transmission of STDs as well as the high
risk groups of STDs. © 2011 WPMH GmbH. Published by Elsevier Ireland Ltd. All rights reserved.

Introduction perceptions of university students towards the

Dr. Redhwan Ahmed
Al-Naggar PhD
Associate Professor and
Coordinator of Community
Medicine Department,
International Medical School,
Management and Science
University, Malaysia.
Tel: +603–5510–6868;
Fax: +603–5510–8668.
E-mail address:
radhwan888@yahoo.com
(R.A. Al-Naggar).
Al-Jashamy Karim
Faculty of Medicine/SEGi
University College/Kuala
Lumpur, Malaysia
The importance of sexually transmitted
diseases (STDs) as a major threat to public
health at a global level has increased radically
since early 1980’s [1]. The World Health
Organization [2] estimated that 170 million
new cases of STDs occur each year in Southeast
and South Asia while about seven million
people are living with HIV/AIDS in Asia and
the Pacific Region [3]. STDs are predominantly
found among the young sexually active
members of population, with the highest
rates among 15–29 years old [1]. The main
reasons include biological factors, transmis-
sion dynamics, treatment-seeking behavior
and dangerous sexual behavior [4]. Sexually
transmitted disease plays an important role in
physiological, psychological and social aspects
of adolescent [5]. STDs also have devastating
effects on the capacity to reproduce, perinatal
infection rates and incidence of genital
cancers [6], and the increased risk of cervical
cancer [7,8]. Complicating factors such as
migration, stigma, socio-cultural practices,
human behavioral changes and prostitution
have also affected the people with STDs [9].
Lower self-esteem, depression, guilt feeling
and shame were reported as psychological
impacts of STDs [10]. Malaysia has undergone
rapid modernization including rising age of
marriage [11] resulting in the increased sexual
exposure among Malaysian youth [12,13]. The
objective of this study was to explore the
sexually transmitted diseases.
Methods
An in-depth interview was conducted among
26 undergraduate university students in
September, 2009. Fourteen students took
part from the Faculty of Health and Life
Sciences (FHLS), eight from the Faculty
of Business Management and Professional
Studies (FBMP) and four from the Faculty of
Information Sciences and Engineering (FISE),
Management and Science University (MSU),
Shah Alam, Malaysia. We randomly selected
the participants from the respective faculties.
Immediately after the end of class, we invited
the students with a description of study pur-
pose to participate in the study. The students
who agreed were invited to the library for
interview. We preferred library because it
is quit place and safe from disruption. We
took permission from the participants to write
down notes of their response. The interview
lasted for approximately 40–50 minutes.
The interviewers followed the standardized
protocol to ensure that all the interviews were
conducted in a similar manner. Throughout
the interview, the participants discussed an
identical set of questions. Data were manually
analyzed as the sample size was small.

© 2011 WPMH GmbH. Published by Elsevier Ireland Ltd. jmh Vol. 8, Suppl. 1, S87–S90, April 2011 S87
 Article
Results
Socio-demographic characteristics
Twenty-six undergraduate university students
aged 18 to 26 years participated in the study.
The majority of the participants (61.5%) were
21–23 years old. Half of the participants (50%)
were male. More than two third participants
were Malay (69.3%), whereas Indian, Chinese
and others respectively consisted of 15.3%,
7.7% and 7.7% of participants. The majority
of them were from FHLS followed by FBMP
(30.7%) and FISE (15.3%).
Awareness, causes and mode of transmission of
STDs
Around three fifth participants (73%) had
heard about the STDs while 65% knew about
the general causes of STDs such as bacteria and
viruses. Sexual intercourse was considered as
the most common mode of the transmission
of STDs (46%) followed by oral sex (8%).
Equal number of participants considered
drugs abuse by sharing needles (4%), infected
mothers to fetus transmission (4%), multiple
sex partners (4%) and blood transfusion
(4%) as other modes of transmission. Of
the participants who did not know the
mode of the transmission of STDs (31%),
61.5% could not tell whether STDs can
be transmitted by kissing and touching
whereas 38.5% considered that STDs can
be transmitted through kissing the infected
person or touching the waist area of the
infected person.
The risk groups to STDs
Seven participants reported multiple sex
partners as the most high risk group to
STDs followed by prostitutes (15%), drug
addicts (8%) and teenagers (8%). Equally one
participant reported mentioned guest relation
officer, baby of infected mother, homosexuals,
sex abuser were equally as high risk groups.
However, seven participants (27%) did not
know about the risk groups of STDs.
Reasons for the raising STDs cases in Malaysia
More than two fifth participants (42.3%) men-
tioned that STDs increased rapidly every year
in Malaysia because of multiple sex partners
followed by lack of sex education (19.2%),
modern lifestyles (19.2%) and ignorance about
hygiene (11.5%).
S88 jmh Vol. 8, Suppl. 1, S87–S90, April 2011
Preventive measures and treatments of STDs
The majority of the participants (57.7%)
considered safe sex practice using condom can
prevent STDs followed by public education
42.3%. Although the majority of the partici-
pants knew about the treatment of the STDs
using antibiotics and antiviral, 38.5% had no
idea about the treatment of STDs.
Discussion
Sexually transmitted diseases can be con-
trolled by reducing the risk of trans-
mission in any sexual practice by using
condom [14]. Education can help young people
to make informed decisions about their sexual
health [15]. The results of this study provide
supplementary evidence of the critical need
to educate underground university students
about reproductive health issues and STDs.
As this study indicated, the majority of
the students heard about STDs. Almost
similar finding was reported by Mwambete
and Mtaturu [16]. However, college students’
knowledge about HIV was quite good and
significantly better than that of other risk
factors of STDs. Conversely, in a study in
Taiwan, Tung et al. [17] reported that there was
a poor knowledge about HIV among college
students. Almost similarly, in an Indian study,
adolescent girls had poor knowledge on STDs
and HIV/AIDS [18]. It has been suggested that
education about HIV has overshadowed other
sexually transmitted disease teaching [19,20].
The result indicated that the most of the
participants (65%) knew about the general
causes of STDs such as bacteria and viruses.
This may be due to the fact that the most of the
study participants recruited from FHLS had
knowledge about the causes of STDs. Twelve
(46%) participants mentioned the sexual
intercourse as the most common mode of the
transmission of STDs followed by oral sex (8%).
Tung et al. [17] also reported that fewer than
half of his study participants were aware that
HIV could spread through infected semen.
As this study further indicated, STDs can
transmit through kissing the infected person
or touching the waist area of the infected
person. Misperception was also reported in
another study where participants believed
that HIV could spread through mosquito bites,
toilet seats, or swimming pools [17]. Lack of
information about HIV among USM students
and misconceptions among undergraduate
pharmacy students about the transmission
of HIV including HIV is preventable by
avoiding mosquito bites and is transmittable
 Article

through food, saliva, urine, and feces were
also found in another study [21]. As this
study further indicated, multiple sex partners,
lack of sex education, modern lifestyles
might contribute to the increase the STDs
in Malaysia. Ignorance about hygiene (11.5%),
sanitation and cleanliness also contributed to
the increase of the STDs. Such increase might
be due to the social changes that Malaysia is
experiencing [13].
The majority of the participants mentioned
that the best way to prevent STDs is
practicing safe sex by using condom (57.7%)
followed by and public education (42.3%).
McManus and Dhar [18] found that 22% of
students did not know that used condoms can
protect STDs. There is evidence that condoms
are the only technology available that can
prevent STDs [22]. Condom use can reduce
the risk of transmission of HIV, Gonorrhea
and Chlamydia and Herpes simplex virus [23].
Study indicates that drug abuse, STDs and
HIV may be treated as a closely linked
issue for greater impact in educating the
masses [24]. Since Muslims are vulnerable to
these temptations, they should be exposed to
the firm message of Islam against adultery
and fornication (zina ) and drug abuse [25].
Islam protects against HIV by promoting
family values as well as male circumcision,
and by prohibiting non-marital sex, drug
use, homosexuality and alcohol [26,27]. This
study further indicated that the majority
of the participants (61.5%) knew about the
treatment of the STDs using antibiotics
and antiviral. This may reflect the previous
understanding of STDs among the participants
recruited from the FHLS.
Conclusions
Most of the study participants heard about
STDs, knew about the causes of STDs and
some of the preventive measures. However,
more than half of the participants did not
know about the mode of the transmission; of
these, the majority did not know the high risk
groups to STDs. Further research is needed
to develop and evaluate methods in STDs
education among university students.
Acknowledgements
The authors wish to thank all of the
undergraduate students who kindly agreed to
participate in this study.
Conflict of interest statement
The authors have no conflict of interest to
report.

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