Sexually Transmitted Infection Prevalence and Determinants Among Sexual Health Clinic Attendees in Bucharest, Romania

Sexually transmitted infections (STIs) remain a significant public health concern in Romania, yet limited data exist on STI prevalence and knowledge, attitudes, and practices (KAP) among at risk populations. This study aims to assess STI prevalence and KAP among attendees of a free-of-charge STI testing campaign and to examine associations between knowledge, risk behaviors, and laboratory-confirmed STI status.

A cross-sectional study was conducted at Colentina Clinical Hospital, Bucharest, from June to November 2025 during a free-of-charge STI testing campaign. Participants (n = 70) completed a structured KAP questionnaire using 7-point Likert scales and underwent comprehensive polymerase chain reaction (PCR) testing from multiple anatomical sites for bacterial STIs (including Chlamydia trachomatis, Neisseria gonorrhoeae, Mycoplasma genitalium, Ureaplasma urealyticum), plus serological testing for syphilis (VDRL/TPHA), human immunodeficiency virus (HIV), and hepatitis B and C.

The sample was predominantly male (84.3%) and men who have sex with men (MSM, 70.0%), with a mean age of 33.3 ± 11.3 years. Despite high overall knowledge (85.3%), STI prevalence was substantial: active syphilis 17.7%, HIV 11.5%, and Chlamydia trachomatis 8.6%, while Ureaplasma urealyticum was the most commonly-detected organism (21.4%). Overall, 35.5% had clinically relevant bacterial STIs. Participants with STIs showed significantly higher agreement with specific misconceptions. Chlamydia trachomatis was significantly more frequent in non-MSM (23.8%) than MSM (2.0%, p = 0.008), while Neisseria gonorrhoeae infections (5.7%) occurred only in MSM, with 80% isolates detected extragenitally. Preference for quarterly screening dropped from 62.9% (if free-of-charge) to 17.1% (if paid) (p = 0.002).

In this first comprehensive STI study among a predominantly MSM cohort in Romania, prevalence was high (35.5% for clinically relevant bacterial STIs), with multisite testing proving essential. Despite high general knowledge, specific misconceptions predicted positive STI status, while cost remained a major barrier to optimal testing frequency. These findings support implementation of free-of-charge, multisite screening programs and targeted interventions addressing specific KAPs.