Abstract
Background:
Dating applications have become increasingly popular platforms for meeting romantic partners, but their association with sexually transmitted infections (STIs) remains a topic of concern.
Aim:
To study the prevalence of the use of dating apps among patients with STIs and analyze the behavioral patterns and sexual practices in this group.
Patients and Methods:
This was a cross-sectional survey of 32 questions assessing dating app usage, sexual behaviors, and STI diagnoses in patients attending the STI clinic.
Results:
We interviewed 150 patients with STIs and divided them into two groups: group A (those who used dating apps; 49/150, 32.6%) and Group B (those who did not; 101/150, 67.4%). The mean age of group A was significantly lower (27.31 ± 7.11 years vs. 32.16 ± 9.4; P < 0.001). Male gender was predominant in both group A (45/49, 91.8%) and group B (66/101, 65.3%). Group A reported earlier sexual debut (19.9 ± 3.4 years vs 21.72 ± 2.5 years; P < .001), were more likely to be single (65.3% vs 26.7%; P < 0.001, Odds ratio: 6.2), and had multiple sexual partners (group A: offline: 4 partners; online: 11 partners vs. group B: 2 partners). Additionally, group A was more likely to be homosexual (20.4% vs 3%; P < .001) or bisexual (28.6% vs 2%; P < .001) and had a higher prevalence of human immunodeficiency virus coinfection (18% vs 6.9%; P = 0.03, Odds ratio: 3.02).
Limitations:
Cross-sectional design, single center study and self report reporting of dating app use and sexual behavior.
Conclusion:
Dating app usage was associated with younger age, male gender, and increased STI risk behaviors (earlier sexual debut, higher partner number, and homosexual or bisexual).
Keywords: Bumble, dating applications, Grindr, India, sexually transmitted infection, Tinder
Introduction
The internet has revolutionized interpersonal relationships, where people are finding their romantic and sexual partners in the comfort of their homes using smartphones. Studies conducted in different geographical locations have shown that around 40% of single adults are looking for an online partner, and around 25% of new couples meet through this means.[1,2] Sexually transmitted infections (STIs) are a significant public health problem worldwide, affecting the quality of life, and causing serious morbidity and mortality. High-risk behaviors associated with STI acquisition include having multiple sexual partners, inconsistent condom use, use of psychoactive substances during the sexual act, exchange of sex for money, and sex with high-risk sexual partners (e.g., injecting drug users).[3,4] Dating apps have made meeting people for dating and sexual relations convenient, leading to an increase in multiple and unknown sexual partners, thus categorizing app use as a high-risk behavior.
Research on relationships between STIs, sexual behaviors, and online dating is an emerging area of interest. However, the literature has been primarily focused on gay, bisexual, and men who have sex with men (MSM), and similar studies are lacking in India. With this study, we aimed to study the prevalence of the use of dating apps among patients with STIs and to analyze the behavioral patterns and sexual practices in this group.
Patients and Methods
This cross-sectional paper-based survey, retrospectively approved by the institute ethics committee (Institutional Ethics Committee, PGIMER, Chandigarh; Reference number: INT/IEC/2024/SPL128), recruited patients visiting the STI clinic from January to December 2023, ensuring informed consent and patient anonymity.
Patients were interviewed using a structured questionnaire to collect information on socio-demographic characteristics, sexual history, and dating app usage. Data were gathered on gender identity (male, female, transgender, or others), relationship status (committed relationship, not in a relationship, married, or other), and sexual orientation (attracted to the opposite sex, same-sex, or both sexes). Details regarding the nature of sexual acts (homosexual, heterosexual, genito-genital, genito-oral, or peno-rectal) and safe sex practices, including condom use, were documented. Participants were also asked about their awareness of various STIs and the use of psychoactive substances during sexual intercourse. Inquiries regarding dating app usage included the purpose of using such applications (seeking a long-term relationship, casual dating, casual sex, making friends, out of boredom, or just for fun), number of applications used, duration of usage, number of sexual partners met through apps, and whether they accessed free or paid subscriptions. Investigations and treatment were carried out according to departmental protocol, the Centre for Disease Control and Prevention (CDC) guidelines, and the National AIDS Control Organisation (NACO) guidelines.
Statistical analysis
Categorical data was reported as frequency (%), and continuous variables as mean ± standard deviation (SD) (range). Fisher’s exact test or the Chi-square test was used to compare categorical variables. A P value of less than .05 was considered statistically significant. An odds ratio (OR) with 95% confidence intervals was calculated. Statistical analyses were performed using SPSS version 27.0 (SPSS; IBM Corp, NY).
Results
A total of 150 patients with mean age of 30.57 (SD- 8.9; range 17- 63) years, 111 (74%) male and 39 (26%) female, [Table 1] were recruited and divided into two groups; group A who used dating apps (49/150, 32.6%) and group B who did not (101/150, 67.4%). The mean age of patients in group A and group B was 27.31 ± 7.11 (17-44) years and 32.16 ± 9.4 (18-63) years, respectively (P < 0.001). Male gender was predominant in both group A (45/49 males [91.8%] vs. 4/49 females [8.2%]; P < .001) and group B (66/101 males [65.3%] vs. 35/101 females [34.7%]; P < .001).
Table 1.
Socio-demographic details of both the groups
| Group A (Dating app users) | Group B (Dating app non-users) | Significance (P) | |
|---|---|---|---|
| Number of patients | 49 (32.6%) | 101 (67.4%) | |
| Mean age Range | 27.31±7.11 years 17-44 years |
32.16±9.4 years 18-63 years |
<.001 |
| Gender distribution | Males: 91.8% Females: 8.2% |
Males: 65.1% Females: 34.7% |
<.001 |
| Education level | |||
| Post-graduate level | 8.2% | 7.9% | 0.79 |
| Graduate level | 61.2% | 38.6% | |
| 12th grade | 20.4% | 23.8% | |
| 10th grade | 10.2% | 21.8% | |
| 5th grade | 0 | 5% | |
| Not formally educated | 0 | 3% | |
| Employment status | <.001 | ||
| Employed | 57.1% | 68.3% | |
| Self-employed | 8.2% | 2% | |
| Students | 28.6% | 9.9% | |
| Un-employed | 6.1% | 19.8% | |
| Living arrangement | 0.002 | ||
| Living with family | 59.2% | 85.1% | |
| Living with friends/hostel | 26.5% | 9.9% | |
| Living alone | 12.2% | 5% | |
| Other | 2.1% (army) | 0 | |
| Relationship status | |||
| Married | 20.4% | 59.5% | <.001 |
| Currently in a relationship | 10.2% | 11.8% | OR: 6.2 (being single who use dating apps versus those who do not) |
| Divorced/separated | 4.2% | 2% | |
| Not in a relationship | 65.3% | 26.7% | |
| Sexual orientation | |||
| Attracted to the opposite sex | 51% | 95% | <.001 |
| Attracted to the same sex | 20.4% | 3% | |
| Attracted to both sexes | 28.6% | 2% | |
| Mean age of first sexual encounter | 19.9±3.4 years | 21.72±2.5 years | <.001 |
| Number of sexual partners (mean) | Through dating apps: 11 Offline: 4 |
2 | |
| Contraceptive | |||
| Condom | 59.2% | 47.5% | 0.22 |
| None | 40.8% | 51.5% | |
| Others | 0 | 0 | |
| Psychoactive substance use | 18.4% | 15% | 0.68 |
| Engagement in commercial sex workers | 2% | 19% | 0.78 |
| STI awareness | |||
| HIV | 100% | 97% | 0.07 |
| Anogenital warts | 36.7% | 39% | |
| Syphilis | 30% | 16% | |
| Herpes | 24.5% | 13% | |
| Genital molluscum | 14.3% | 3% | |
| Gonorrhoea | 12.2% | 0 | |
| Chlamydia | 4.1% | 1% | |
| STI diagnosis | |||
| Anogenital warts | 42.8% | 51.4% | 0.26 |
| Syphilis | 40.8% | 26.7% | |
| Herpes | 8.2% | 10% | |
| Genital molluscum | 8.2% | 11.9% | |
| HIV co-infection | 18% | 6.9% | 0.03 OR 3.02 |
Significant P<.05; OR: Odds Ratio; STI: Sexually transmitted infections
There was no significant difference in the education level between the groups. Employment status exhibited a significant difference between the two groups (P < .001), with a higher proportion of patients identifying as students in group A compared to group B. There was also a significant difference in living arrangements between the two groups, with patients in group A staying alone or with friends/hostel [Table 1, P = 0.002]. The relationship status also differed significantly between the two groups (P = .001), with the odds ratio for not being in a relationship among group A compared to group B calculated at 6.2 [Table 1].
Dating app users had a significantly lower mean age of first sexual encounter (group A: 19.9 ± 3.4 [range = 15-28] years vs group B: 21.72 ± 2.5 [range = 16-30] years; P < .001). The average number of sexual partners was highest in group A (offline: 4 partners; online: 11 partners [range: 2-80]) as compared to group B (2 partners [range: 1-10]).
The sexual orientation differed in both groups (attracted to the opposite sex: 51% [group A] vs. 95% [group B]; attracted to the same sex: 20.4% [group A] vs 3% [group B]; attracted to both the sexes: 28.6% [group A] vs 2% [group B]; P < .001). In group A, all patients who were attracted to the same sex were male; with 20% identifying as active partners, 50% as passive partners, and the remaining 30% as both. Out of 14 (28.6%) patients in group A, who were attracted to both sexes, only one was female, and the rest were males. Among these, five were active partners, seven were passive, and two preferred being both. In group B, all patients attracted to the same-sex or both sexes were male, and they reported engaging in both genito-oral and peno-rectal modes of contact. Three out of five patients preferred to be passive partners, while the remaining patients expressed a preference for being both active and passive.
The contraceptive practices, the use of psychoactive substances during sexual intercourse, and engagement in sex with sex workers were comparable in both groups. None of the patients in the group reported an unwanted pregnancy.
Dating application use
Out of 49 patients utilizing dating apps, 18 (36.7%) used a single app, while 31 (63.3%) used two or more apps. Among 88 responses on platform names, Tinder was the most used dating application [Table 2]. When inquired about their motives for using online platforms, 90 responses were collected from 49 patients. Of these, 54.1% cited meeting people for casual sex, 24.3% for casual dating, 13.5% for finding long-term relationships, and 8.1% for finding friends or unspecified reasons. The behaviors related to the use of dating applications have been summarized in Table 2.
Table 2.
Behavioural characteristics of dating app users (n=49)
| Characteristics | Percentage |
|---|---|
| Dating app used | |
| Tinder | 40.9% |
| Grindr | 23.9% |
| Bumble | 25% |
| Hinge | 4.5% |
| 2.3% | |
| 3.4% | |
| Time of start of dating apps | |
| >1 year | 63.3% |
| 1 month-1 year | 32.6% |
| <1 year | 4.1% |
| The interval between an online match and meeting people | |
| 1 day | 71.4% |
| 1-7 days | 10.3% |
| 7-28 days | 18.3% |
| >28 days | 0 |
| Time spent per day on applications | |
| <1 hour | 71.4% |
| 1-4 hours | 26.5% |
| >4 hours | 2.1% |
| Motives for using apps | |
| Casual sex | 54.1% |
| Casual dating | 24.3% |
| Long-term relationships | 13.5% |
| Find friends/no reason | 8.1% |
| Sexual encounters with people from different cities | 45% |
When asked about discussing STIs with online partners, only two patients (4.1%) reported doing so. Upon presentation to the STI clinic, 69.4% of patients ceased their use of dating apps. Among those who stopped, 36.7% cited STIs as the reason for discontinuation, 22.4% disliked the online mode, and 6% reported interference with their work or studies. Only one patient stopped due to entering a long-term relationship.
STI awareness
The awareness of various STIs did not differ significantly between the groups (P = 0.07). All patients in group A (100%) and 97% in group B were aware of HIV. The other most commonly known STIs were anogenital warts (group A: 36.7% vs. group B: 39%), syphilis (group A: 30% vs. group B: 16%), and herpes (group A: 24.5% vs. group B: 13%). A smaller proportion acknowledged molluscum (group A: 14.3% vs. group B: 3%), gonorrhea (group A: 12.2% vs. group B: 0%), and chlamydia (group A: 4% vs. group B: 1%). None of the patients recognized chancroid, trichomoniasis, lymphogranuloma venereum, or other causes of urethritis as STIs.
STI diagnosis
The most prevalent diagnosis among both groups presenting to the STI clinic was anogenital warts (group A: 42.8% vs. group B: 51.4%), followed closely by syphilis (group A: 40.8% vs. group B: 26.7%). Of the total syphilis cases, 10.2% were categorized as primary syphilis, 26.6% as secondary syphilis, and 63.2% as latent syphilis of unknown duration. Other recorded STIs included herpes (group A: 8.2% vs. group B: 10%) and genital molluscum (group A: 8.2% vs. group B: 11.9%). Statistical analysis revealed no significant difference between the groups in these diagnoses (P = .262).
However, the presence of HIV co-infection exhibited a significant difference between the two groups. In group B, 6.9% of patients were co-infected with HIV, whereas among group A, this figure rose to 18%, with the difference being statistically significant (P = .033). The Odds Ratio was calculated at 3.02, indicating a higher likelihood of HIV co-infection among dating app users compared to non-users.
Discussion
Geosocial networking dating applications provide web-based platforms that use global positioning system (GPS) location to match individuals within their geographic radius for making sexual or romantic connections. In this study, we investigated the prevalence of use of these dating applications and sexual behavior among patients presenting to STI clinic through a cross-sectional paper-based survey. Among the 150 patients recruited from the STI clinic, nearly one-third (n = 49) reported using dating apps. Similar to the previous studies, Tinder emerged as the most popular dating application among the study participants, followed by Bumble and Grindr.[5,6,7] In a survey of 409 American university students, the main motivations for using dating apps were for fun and to meet people.[8] Other studies have identified forming romantic or sexual connections, self-validation, and low self-esteem as motivations for using these apps.[9,10,11,12] In our study, 54.1% of patients used these apps to meet people for casual sex, while 24.3% used them for casual dating.
Young adults are the primary users of dating apps, and they have a higher tendency towards risky sexual behaviors.[9,13,14,15,16] They often lack discussions about safe sex or STIs and have multiple unknown sexual partners. The various studies on the effect of dating apps have been summarised in Table 3. Similar to other studies that reported the prevalence of dating app users between 24 and 30 years of age, the dating app users in our study were also substantially younger, with a mean age of 27.31 years, compared to non-users, who had a mean age of 32.16 years.[17,18] Although males predominated in both groups, a striking gender imbalance was also observed among dating app users in our study. A study by Weiser et al.[19] also indicated that 60% of these application users were male. It has been seen in other studies also that males are more likely to use dating apps.[18,20] This gender disparity echoes the typical gender dynamics observed on dating platforms, where male users often outnumber females. This skewed gender distribution may also be influenced by factors such as underreporting among female users due to societal stigma or safety concerns associated with online dating or the perceived risks of disclosing such information in a clinical setting. A study by Tavares et al.[21] about the sexual behaviors of college students found that unsafe sex was present in both sexes, but men had a greater number of sexual partners and less protective attitudes.
Table 3.
Summary of previous studies on dating apps
| Author (study) | Sample size | Inclusion criteria | Results | Conclusion |
|---|---|---|---|---|
| Buhi et al. (Evaluating Internet as STI risk environment for teens)[16] | 273 | Age: 13-19 year | Teens reporting online sex partners were more likely to be male, have a history of same-sex sexual activity, have a higher number of sex partners, and have lower age at first vaginal sex. | Meeting a sex partner online was not associated with past or current STDs; it was associated with other sexual risk behaviors. |
| McFarlane et al. (Internet as risk environment for STI)[17] | 856 | Age: >18 years | Internet sex seekers reported more previous STIs, more partners, more anal sex, and more in MSM. | Clients who seek sex using the Internet appear to be at greater risk for STIs than clients who do not seek sex on the Internet. |
| Choi et al. (Impact of using dating applications on sexual behaviors in college students in Hong Kong)[22] | 666 | College students | Factors associated with having unprotected sexual intercourse with more lifetime sexual partners included the use of dating apps, having one’s first sexual intercourse before 16 years of age, being older, being a current smoker or drinker | They found a robust association between using dating apps and sexual risk behaviors, suggesting that app users had greater sexual risks. |
| Tavares et al. (Dating apps, sexual behaviors and attitudes of college students in Brazil)[21] | 359 | College students aged ≥18 years | Unsafe sex was present in both biological sexes, even with a positive attitude toward sexual health reported by women. Men had a greater number of sexual partners and less protective attitudes. Most students were not tested for STIs after intercourse with a casual partner | They found risky sexual behaviors in college-aged app users. |
| Al-Tayyib et al. (Finding sex partners online-risk for STI)[23] | 14955 | Retrospective Case Control Study Cases: patient testing positive for chlamydia/gonorrhea | The association between recent internet sex partner and current Chlamydia/Gonorrhoea infection was not significant for MSM (risk ratio (RR): 1.12, 95% confidence interval (CI): 0.84 to 1.49) and women (RR: 0.81, 95% CI 0.45 to 1.48). | Sexual encounters with internet partners did not appear to be associated with an increased risk of current infection among people seeking care at a sexual health clinic. |
CI: Confidence Interval; MSM: Men who have sex with men; RR: Risk Ratio; STI: Sexually transmitted Infections
Studies by Shapiro et al. and Neyt et al. have found a direct relationship between the use of dating apps and the level of education.[2,24] Although no significant difference in education status was found between the two groups, it was observed that all patients who reported using dating apps had at least a high school or secondary level of education. Consistent with previous research, the study found that a higher proportion of dating app users lived alone or with friends, and they were six times more likely to be single compared to non-users.[25]
Previous studies have also suggested that MSM (men having sex with men) who use these apps tend to have more sexual encounters, more frequent anal intercourse, unprotected sex, and large number of sexual partners.[18,26,27] While a significant proportion of individuals in both groups in our study identified as heterosexual, there was a higher percentage of patients attracted to the same sex or who identified as bisexual among dating app users. Dating app users reported a substantially higher average, with four partners met offline and 11 online, and one individual reported an exceptionally high number of 80 partners met through dating apps in a single year. The higher number of sexual partners among dating app users may be attributed to the accessibility and ease of connecting with potential partners through these platforms, leading to increased opportunities for sexual encounters. The earlier sexual debut reported by dating app users further emphasizes the influence of these platforms on sexual behavior.
Choi et al. studied factors associated with unprotected sexual intercourse, including the use of dating apps.[28] Contrary to the previous studies that users of dating applications may be less likely to use contraception compared to non-users, our study did not find significant differences in contraceptive behaviors between the two groups. Green et al.[29] concluded in their study that risky sexual behaviors, including relationships after alcohol and other drugs, were most common in people met through dating apps. However, the use of psychoactive substances during sexual activity did not differ between our groups.
In a study conducted at a tertiary care center in India, the predominant sexually transmitted infections (STIs) were found to be herpes genitalis, condyloma acuminata (anogenital warts), and syphilis. The viral STIs outnumbered bacterial STIs in this group of patients.[30] Aligning with this study, anogenital warts emerged as the most common diagnosis in both groups, indicating a high burden of this STI among the study population. Syphilis was identified as another prevalent STI. This finding parallels the increasing prevalence of syphilis worldwide.[31] Anogenital warts and other STIs, including herpes and genital molluscum, exhibited comparable prevalence rates, indicating similar risk profiles for these infections across both groups. The most striking difference was observed in the prevalence of HIV co-infection, with odds of dating app users being thrice as likely to be co-infected with HIV as compared to non-users.
Orellana et al.[32] reported an annual increase of 9% to 15% in STI incidence and prevalence among males and females in the United States from 2015 to 2019, attributing this rise to dating app usage. This trend is expected to persist, further increasing STI rates. While dating apps revolutionize how people connect, they also pose risks to mental and sexual health. The ease of access and anonymity of these apps can lead to high-risk behaviors, such as unprotected intercourse and multiple partners without proper sexual history inquiries, contributing to the surge in STIs. As healthcare providers, it is crucial to inquire about patients’ dating app usage during clinical assessments, as these apps may become a significant STI risk factor with their growing popularity.
Limitations
Our study offers insights into the link between dating app usage and STIs, but it has limitations. The cross-sectional design limits causality establishment between app usage and STI acquisition. Conducted at a single tertiary care center with a relatively small sample size, our findings may not be generalizable. The data on dating app usage and sexual behaviors were self-reported, introducing the potential for recall bias.
Conclusion
Dating app usage is identified as a significant factor associated with younger age, male gender, and high-risk sexual behaviors, including earlier sexual debut, multiple sexual partners, and homosexual or bisexual orientation. Given these findings, routine assessment of dating app usage among patients presenting to STI clinics is recommended, as it may serve as an indicator of high-risk sexual practices.
This study highlights the need for further research to develop targeted interventions for dating app users, focusing on promoting safe sexual practices and reducing STI risks. Future studies can explore the use of digital platforms, including dating apps and social media, as tools for delivering cost-effective and scalable STI/HIV prevention campaigns. Longitudinal studies may also be valuable in establishing causal relationships between dating app usage and STI acquisition over time. While digital platforms may facilitate high-risk behaviors, they also present an opportunity to implement cost-effective, scalable, and engaging STI/HIV prevention strategies through social media and digital outreach programs at the community level.
Consent to participate
Consent was obtained from each patient prior to completing the anonymous form.
Conflicts of interest
There are no conflicts of interest.
Use of artificial intelligence (AI)
The preparation of this manuscript was carried out entirely by the authors without the use of artificial intelligence technologies.
Funding Statement
Nil.
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