The promise of integrated representative surveys about sexually transmitted diseases and behavior

Background: It has been difficult to conduct representative surveys measuring both sexually transmitted disease prevalence and behavioral data. This article reviews the literature, describes a recent pretest of the feasibility of integrated surveys, and discusses the potential implications. Methods: Several national surveys are reviewed, including the National Health and Nutrition Examination Surveys, National Health and Social Life Survey, and National Survey of Adolescent Males. The 1994 pretest of the National Survey of Adolescent Males collected urine specimens of male respondents, which were tested for Chlamydia trachomatis using ligase and polymerase chain reaction tests. Results: There have not been any prior national surveys that collect clinical measures of STD infection and detailed behavioral data. In the pretest, 85% of the eligible interview respondents provided a urine specimen. Of those tested, 6% were positive for C. trachomatis. Conclusions: Combining behavioral surveys with collection of urine specimens for STD testing in representative samples is feasible. However, STD testing adds new operational and ethical challenges to the conduct of household surveys.