Prevalence of Symptom-based Sexually Transmitted Infections and Related Factors among Incarcerated Men in Iran, 2013

Background: Prisoners are at higher risk for sexually transmitted infections (STIs) than the general population. This study reported the prevalence and correlated factors of STI-related symptoms among male prisoners in Iran. Methods: Participants were selected from 27 prisons across 16 Iranian provinces in 2013 using a multistage cluster sampling (N = 5490). Men aged ≥18 years who spent at least one week in prison and self-reported having had sex during the previous year were eligible and asked if they have had penile discharge (PD) or genital ulcers (GU) within the last year. Demographic variables, HIV/STIs-related knowledge, STIs care-seeking practices, HIV self-perceived risk, history of substance use, and sexual behaviors were collected by face-to-face interviews. HIV tests were completed using the ELISA method. Factors associated with STIs-related symptoms were examined using logistic regression models, and adjusted odds ratios (AOR) along with their 95% confidence intervals (CI) were reported. Results: Of 2,620 eligible male prisoners (mean age ± SD = 35.7 ± 8.9), 6.9% reported symptoms for PD, GU, or both; of whom 36.2% had not sought STIs care inside prison. A history of injection drug use (AOR = 2.14; 95% CI: 1.45, 3.14), having access to condoms inside prison (AOR = 1.57, 95% CI: 1.08, 2.82), self-perceived risk of HIV (AOR = 1.52, 95% CI: 1.03, 2.24), and HIV-seropositivity (AOR = 3.30, 95% CI: 1.02, 10.61) were positively and having sufficient STIs-related knowledge (AOR = 0.63, 95% CI: 0.44, 0.89) was negatively associated with reporting STIs-related symptoms. Conclusion: Despite the low prevalence of STIs among Iranian prisoners, initiation of screening among high-risk prisoners, including people who inject drugs and prisoners living with HIV, may prevent subsequent health effects. Current HIV/STIs prevention policies across Iranian prisons to help improve prisoners' HIV/STIs knowledge and encourage their HIV/STIs preventive practices should be reinforced.