Methods: Thirty-seven adolescents aged 15-17 were recruited from a community center serving two contiguous North Carolina counties with high STI rates. We conducted 4 focus groups stratified by gender in April 2006. Participants completed a brief questionnaire assessing their sexual, reproductive and STI histories. Focus group discussions assessed adolescent knowledge of factors that affect STI transmission as well as barriers and facilitators of the adoption of 5 STI prevention behaviors including STI testing. Focus groups were audio-taped, transcribed, and the data entered into a qualitative analysis package. Coding was performed by two independent individuals using grounded theory.

Results: Twenty females (54%) and 17 males (46%) participated. The average age was 16 and most (n=25, 69%) were sexually active. Boys and girls were aware of recommendations for annual STI testing among adolescents or following a change in sexual partners. Some girls reported seeking STI testing or discussing getting tested with new partners. The primary facilitator of STI testing was learning or suspicion that a partner had sex with someone else. Girls sought testing if providers recommend it during annual gynecological exams or contraceptive refill visits. Boys commonly sought testing after sexual encounters with partners they suspected were high risk. Multiple barriers to STI testing were provided, including lack of transportation, lack of male-friendly testing sites, fear of results, fear that parents would find out given the small community, and fear of partners' response. Belief that one could not possibly be infected was a commonly mentioned barrier for girls. A common barrier among boys was peer pressure to forgo testing when a female partner had a good social reputation (Man, you ain't got to do that. She straight.).

Conclusions: These adolescents were aware of recommendations that adolescents get tested at least annually, but routine testing is not part of their repertoire of health-related behaviors, except among girls attending annual gynecological exams or family planning visits. Interventions should seek to make STI testing routine for all adolescents, especially for adolescent males.

Sources of Support: Robert Wood Johnson Foundation, NIH Roadmap K12 Award (1 KL2 RR024154-01)