The finding:
Taiwan’s National Health Insurance Research Database was used to enroll adolescents and young adults with schizophrenia, along with matched controls. The authors report that patients with first episode psychosis were at a higher risk for contracting any of the sexually transmitted infections (STI) included in the study, often at a younger age. The risk increased with male gender, adolescent age, comorbid substance use, and severity of schizophrenia. Compliance with antipsychotics appeared to confer some protection against contracting STIs.

Strength and weaknesses:
A large patient population, and naturalistic inclusion criteria were strengths of this study. Limitations included lack of information about confounders such as sexual health awareness, duration or nature of symptoms, lifestyle and personal health details. There might be limitations to generalizability, as the STI risk could be influenced by culture and other demographic variables.

Relevance:
STIs are a global public health problem, with younger individuals facing a disproportionate burden of disease. Patients with schizophrenia have lower awareness of safe sex practices, and may engage in behavior that puts them at high risk for STI, such as lack of condom use, multiple partners, using drugs during sex, and exchanging sex for money. Substance use disorders are also overrepresented in this cohort. The stigma surroundings these topics of substance use, psychotic illness and STI can also be a barrier to an open discussion. Screening this higher risk population for STIs, and an open, non-judgmental style of communication are necessary. Comorbid substance use, noncompliance with medications and severe disease may be proxies prompting further enquiry into reproductive health.

Type of Study:
Cohort Study