A case-control study of beliefs and behaviors associated with sexually transmitted disease occurrence in Estonia

Background: Epidemiologic data document rapidly increasing sexually transmi tted disease (STD) rates throughout Eastern Europe. Goal: This case-control study was designed to delineate factors contributin g to the STD epidemic in Estonia. Study Design: For this study, 189 study participants and 112 control subjec ts completed a behavioral questionnaire and underwent testing for Neisseria gonorrhoeae, Chlamydia trachomatis, and Treponema pallidum. Results: The prevalence of STD among the control subjects was 32%. Although the participants believed that condoms prevent STD, only 17% reported cons istent use. Methods believed to prevent transmission included washing the g enitals (65%), urinating (26%), douching (35%), and using oral contraceptiv es (19%). An interaction between sex and travel outside Estonia (odds ratio , 0.1; 95% CI, 0-0.7) reflects the fact that males with STD were more likel y to report travel (46% of participants and 45.5% of control subjects with STD) than were those without STD (16.1% of controls without STD). Conclusions: STD rates are related to high-risk sexual behavior among males traveling outside of Estonia. Intervention is needed to promote understand ing of disease transmission dynamics in this area, and to decrease sexual r isk behavior, particularly in the context of travel.