Self-report of STI symptoms, inconsistent condom use and condom non-use are poor predictors of STI prevalence among men who have sex with men

Background: Biological testing for sexually transmitted infections (STI) are challenged by sample collection and high testing costs, where self-reports are used in predicting STI status. The validity of self-reports among populations at STI risk has not been established clearly. The objective of this paper is to assess the validity of self-reported ‘STI symptoms’, self-reported ‘recent condom non- use’ and ‘inconsistent condom use’ in comparison with laboratory diagnosed STIs among men who have sex with men (MSM) in India. Methods: Data were drawn from a cross sectional Integrated Behavioural and Biological Assessment survey conducted among MSM between 2005–2007 in India. Sensitivity analysis was used to assess the validity of self-reported ‘STI symptoms’, ‘recent condom non-use’ and ‘inconsistent condom use’ with laboratory diagnosed STIs (syphilis/Neisseria gonorrhoeae/ Chlamydia trachomatis). Multiple logistic regressions were used to identify population characteristics which were predictive of concordant self-reporting. Results: Of 3895 MSM surveyed, 14.3% were diagnosed with any STI while 8.3% and 3% reported any STI symptom in past and current respectively. Recent condom non-use and inconsistent condom use was reported by 43.1% and 77.6% of respondents. Self-reported STI symptoms showed very low sensitivity (5–13) in predicting laboratory diagnosis of STIs. Self-reported inconsistent condom use and recent condom non-use showed higher sensitivity than self-reported STI symptoms (50–74.4), but were less specific (21–52.9). Combined self reports showed relatively higher sensitivity (52.3–77.9) and low specificity (18.9–51.8). Overall self reports showed very high negative predictive value (84.4–87.9) and low positive predictive value (12.4–15.7). Education grade more than 12 [AOR: 3.2 (CI 1.7–5.9)], and STI/HIV information exposure [AOR: 1.4 (CI 1.0–2.0)] were predictive of concordant self-reporting of STI symptoms and inconsistent condom use respectively. Knowledge about STIs [AOR: 1.4 (CI 0.9–2.2)] and education grade more than 12 [AOR: 2.5 (CI 1.2–5.3)] were predictive of concordant self-reporting of symptoms/risk. Conclusions: Self-reports of STI symptoms, recent condom non-use and inconsistent condom use were not reliable in predicting true STI status of MSM and thus highlights the limitations in the validity of self-reports collected at different levels in the program setting. The study identified MSM education status, STI/HIV knowledge and information exposure, as predictors of concordant self-reporting of ‘symptoms’ and ‘inconsistent condom use’ with STI laboratory diagnosis, which could be utilized in future survey efforts for improving validity of self-reports