We investigated how STI risk perception relates to behavioural STI risk and STI healthcare (sexual health clinic attendance/chlamydia testing) in the British population.
Natsal-3, a national probability-sample survey undertaken 2010–12, included 8397 sexually-active 16–44 year-olds. Participants rated their risk of STIs (excluding HIV) given their current sexual lifestyle. Urine from a randomly-selected sub-sample of participants (n = 4550) was tested for prevalent STIs ( Chlamydia trachomatis, Neisseria gonorrhoeae, Mycoplasma genitalium, Trichomonas vaginalis).
Most men (64% (95% CI: 62–66)) and women (73% (72–74)) rated themselves as not at all at risk of STIs, 30% (29–32) men and 23% (22–25) women self-rated as not very much, and 5% (5–6) men and 3% (3–4) women as greatly/quite a lot at risk. Although those reporting STI risk behaviours were more likely to perceive themselves as at risk, > 70% men and > 85% women classified as having had unsafe sex in the past year, and similar proportions of those with a prevalent STI, perceived themselves as not at all or not very much at risk. Increased risk perception was associated with greater STI healthcare-use (past year), although not after adjusting for sexual behaviour, indicating in a mediation analysis that risk perception was neither necessary or sufficient for seeking care Furthermore, 58% (48–67) men and 31% (22–41) women who had unsafe sex (past year) and rated themselves as greatly/quite a lot at risk had neither attended nor tested.