Sexually transmitted infections (STIs) also referred to as sexually transmitted diseases(STDs) and venereal disease (VD) are illnesses that have a significant probability of transmission between humans by means of human sexual behavior including vaginal intercourse, oral and anal sex ^{1, 2}. The common STIs which we come across in daily practice are gonorrhea, chancroid, syphilis and chlamidial infections which can be cured and others such as HIV, genital herpes, HPV and Hepatitis B infection cannot be cured ³. STIs is caused by more than 30 different pathogens including bacteria, virus, parasite, protozoa and fungal agents ⁴. STIs present themselves mainly in seven syndromes; these are genital ulcer, urethral discharge, vaginal discharge, lower abdominal pain, inguinal bubo, neonatal conjunctivitis and scrotal swelling ^{5, 6}. Young individuals in the age group of 16–24 years are considered to be at more risk for STIs compared to older adults. The World Health Organization estimates that 20% of persons living with HIV/AIDS are in their 20s and one out of twenty adolescents contract an STI each year ³. If the STIsare not treated adequately, it can lead to various complications such as infertility, urethral stricture, abortions, malignancies, perinatal, and neonatal morbidities ^{7, 8}.Adolescents are disproportionately affected by STIs because of their engagement in unsafe sexual practices such as multiple sexual partnerships, casual sex and inconsistent condom use ⁹. About 333 million people worldwide contract sexually transmitted infections (STIs) yearly ¹⁰.

It is estimated that more than 500 million people still are at high risk of infection; over 140 million persons are infected and about 6 million are in Africa, Middle East, central and south-east Asia and countries in Latin America ⁶. About 60% of young people whose age between14-19 are infected with STIs and females who are at age of 20 years are prone to this case ⁹. In sub-Saharan Africa, comprehensive accurate knowledge about STIs remains low in most countries ¹¹. The situation in Tanzania is worse where about 2.2 million adults and children were estimated to have been infected with STIs including HIV/AIDS ¹⁰ Approximately 17% of children under 15 years of age in Tanzania had been infected with STIs, and about 50% of the STIs occur before the age of 29 years of age^{12, 10}. In Tanzania, it is considered a taboo for teachers and parents to talk with pupils/children about sexual matters, such as sexual relationships, and STIs in schools as well as at home because of cultural and religious barriers ¹³.

No previous research has been conducted in Mlimba division on assessment of knowledge, attitude and practices towards STIs among secondary schools students. Therefore, this study was a descriptive cross-sectional study to assess the knowledge, attitude and practice towards sexually transmitted infections among secondary school students in Mlimba Division, Ifakara, Tanzania.

Socio demographic characteristics of the respondents A total of 365 students took part in the study. Of these, 193(52.9%) were male and 172(47.1%) were female. The age of the respondents ranged from 12 to 23 years, 114(31.2%) aged between 12 to 15 years, 241(66%) aged between 16 to 19 years and 10(2.7%) aged between 20 to 23 years (Table 1).

This study was conducted among secondary school students in Mlimba Division, Tanzania. The purpose of using secondary school students in Mlimba Division was to assess whether these students have good knowledge, attitudes and preventive practices towards STDs. The age category from 16-19 years in this study is in agreement with the characteristics of current student population in secondary schools in Ethiopia ²³. Several studies have revealed that sexually transmitted infections are the cause of multiple complications as a result of lack of knowledge about STIs ¹⁴. Health seeking behavior depends on knowledge about STIs ¹⁵. The proportion of students heard about sexually transmitted infections was 95.9%. This finding was higher than 27% in Udupi Taluk, India ¹⁶, 45.4% in Gondar, Ethiopia ¹⁷, 70.1% in northern Cape Province, South Africa ¹⁸, 79% in Dhaka, Bangladesh ¹⁹, 86.6% in Malaysia ²⁰, 89.9% in Brazil ²¹, 92.4% in Nigeria ¹², and less than 98% in Dar es Salaam, Tanzania ²². The variation observed compared to other studies could be due to the differences in methodology, sample size, and operational definition used. The socio-cultural, socio-economic, and behavioral characteristics of the study participants may play a great role in the variation observed.

The three STDs; AIDS, syphilis and gonorrhea were the most known by the participating students 21.6% males and 16.4% females. However, genital warts, chancroid and herpes were poorly known by the participating students 0% males and 0.6% females. The findings in our study could be these are uncommon types of STDs which are neglected by policy makers.

The present study indicates that teachers and mass media were the sources of information on STDs to secondary school students in Mlimba Division. Students who reported teachers were source of information; 19.2% males and 18.6% females while mass media; 16.2% males and 12.9% females. The results in this study are low compared to studies conducted in Ethiopia where teachers and mass media contributed 48.1% and 39.7% respectively ²⁴. The findings indicate that more effort is needed by teachers and mass media in Mlimba Division to educate secondary school students on sexually transmitted diseases.

The findings of this study showed that the prevalence of sexual initiation among secondary school students is 11.8% males and 24.9% females. This finding is lower for males and higher for females comparing to the study conducted in Ethiopia which was 21.5% ²⁵.

The majority of participating students had knowledge that condom protects people from STDs; 52.1% were males and 45.2% were females. This result is higher than a study done in Ethiopia where 39.7% had knowledge that condom protects people from STDs ²⁶. Sexually active students, 3.6% males and 2.5% females used condom during last sexual intercourse. The result in the present study is lower than the study conducted in Ethiopia which showed 54.7% used condom during last sexual intercourse ²⁶. In the present study, participants who responded to have sex with only one partner were 16.7% males and 20.0% females. The result in the present study is inconsistent with the study done in Ethiopia which showed 54.4% had fewer than two sexual partners ²⁷.

The study revealed that almost all students had heard about STDs. Knowledge regarding modes of transmission, prevention methods was low but the attitude on condom use during sexual intercourse as a preventive measure for STDs was high. Among those who practiced sexual intercourse, some of them did not use condom. The study showed that, signs and symptoms associated with STDs in both males and females were not well known by the students. The mass media and teachers are still major effective means of educating students, on STDs.

It is recommended that parents and teachers should collaborate in educating the students on the reproductive health affairs particularly STDs, in more open and comprehensive way. Government policy on STDs education should be reviewed so as to come up with more concrete ways of fighting STDs including HIV/AIDS.

The author would like to express sincere thanks to the St. Francis University College of Health and Allied Sciences for funding this research. Appreciation goes to the Kilombero District and Mlimba Division authorities and heads of the participating secondary schools for allowing entry into the schools. Also many thanks to the students who participated in the study and gave information that made this work possible.