Low Knowledge, High Risk: Understanding STI Perceptions and Experiences Among Young People in Texas

Abstract Introduction Sexually transmitted infections (STIs) in the United States have remained persistently high for over a decade and disproportionately affect adolescents and young adults. Despite ongoing high STI rates, few qualitative studies have examined why these infections persist among young people, including how educational, policy, and social contexts influence their understanding and behaviors. Methods Theoretical sampling was used to recruit 33 young people ages 15–25 across Texas for in-depth interviews from March to July 2023. Inductive and deductive approaches were used for thematic analysis. Results Findings reveal widespread gaps in STI education across schools, families, and healthcare settings, leaving many participants unaware of STI risk, prevention, and the importance of testing. These information gaps contributed to reliance on online sources, reactive rather than proactive responses to STIs, and misconceptions that often resulted in delayed care-seeking. Participants also described stigma, confidentiality concerns, and cost as barriers to timely care. These challenges were exacerbated by Texas’s broader healthcare landscape. However, participants offered several ideas for improving STI education, prevention, and treatment. Conclusions and Policy Implications Findings highlight how structural conditions produce individual behaviors that increase vulnerability to STIs. They underscore the need for policies that mandate comprehensive sex education, accessible and confidential STI testing, and resources for parents and clinicians on how to engage young people in conversations about STIs.