Sexual health knowledge can have a significant impact on health care–seeking behaviors of adults. The period of life known as emerging adulthood—defined as the time between 18 and 25 years of age—is a transitional phase of development when young people typically move from being under the care and guidance of their parents to college or employment.¹ For many individuals, emerging adulthood is a time when they begin to take responsibility for their own health; however, this stage also coincides with a peak in risky behaviors.^2-4 These behaviors include unprotected sex, engaging in substance use or abuse, and risky driving behaviors, such as driving at high speeds or driving while intoxicated.^3,4 Approximately 39% of high schoolers report ever having sexual intercourse.⁵ Emerging adult populations who are sexually active are at risk for a variety of sexually transmitted infections (STIs), such as chlamydia, gonorrhea, and syphilis. The CDC estimates that persons aged 15 to 24 years make up just over one-fourth of the sexually active population; however, only 50% report being tested for STIs, even though they account for half of the 20 million new STIs that occur in the United States each year.⁶ The rate of STIs in the United States has increased exponentially from 2013 to 2017.⁷ Reported cases of chlamydia, gonorrhea, and primary and secondary syphilis increased for both sexes in persons aged 15 to 19 years and persons aged 20 to 24 years from 2012 to 2016.⁸ The latest data showed the highest rates of infection ever recorded. In a press release by the CDC, preliminary data show that the number of diagnoses of chlamydia, gonorrhea, and syphilis were collectively up 31% in 2017, and there is concern that gonorrhea is increasingly resistant to antibiotics.⁸ 

Emerging adults are considered an at-risk population that has historically had the least health care use, and before implementation of the Patient Protection and Affordable Care Act of 2010, this age group had the least health care insurance coverage.² Because emerging adults tend to have less chronic health conditions than older populations, they may be more likely to receive care at acute-care clinics than at a primary care physician's office when using health care services.⁹ Studies have demonstrated that a greater proportion of ambulatory care for emerging adults was delivered in emergency departments, less care was delivered to men than to women, and an even smaller proportion of care was covered by private health insurance.¹⁰ From 2010-2014, a 2.5-fold increase was estimated for visits to urgent care clinics, with a significant increase in STI testing and diagnoses.¹¹ This trend may result in walk-in and urgent care clinicians shouldering the burden of preventive health education, coupled with the provision of acute care for presenting illnesses or injuries during short office visits. The lack of clear preventive care guidelines for patients older than 21 years, other than the American Congress of Obstetricians and Gynecologists (ACOG) Guidelines for young women, is also problematic.¹² Additionally, the United States Preventive Services Task Force has frequently updated its guidelines, with the most recent guideline published in 2018.¹³ Without clear guidelines for emerging adult patients and their physicians, it is possible that these patients are a population with multiple missed opportunities for care. 

Additional disparities in health care–seeking behaviors, especially for sexual and reproductive health issues, may exist among genders. Prior literature has shown that women seek preventive medical care more often than men.¹⁴ Emerging adult men are more likely than emerging adult women to report no contact with a health care professional and lack an established source of care.² However, it is unclear whether seeking preventive care correlates with increased medical knowledge and improved health outcomes.¹⁴ 

If differences in sexual health knowledge and practices exist across genders, this discrepancy may necessitate additional education for emerging adults, especially during their walk-in acute visits. This intervention has the potential to combine preventive medicine with tertiary care, leading to improved patient outcomes in emerging adults’ future overall health, in addition to their sexual and reproductive health. Therefore, the purpose of this study was to assess sexual health knowledge of emerging adult patients at acute-care health centers by gender.