Sexually Transmitted Diseases Among Adults Who Had Been Abused and Neglected as Children:A 30-Year Prospective Study

Abstract

Objectives. We examined associations between childhood abuse and neglect and the risk in adulthood for sexually transmitted diseases.

Methods. In a prospective cohort design, we matched children aged 0 to 11 years with documented cases of abuse or neglect during 1967 to 1971 with a control group of children who had not been maltreated (754 participants in all) and followed them into adulthood. Information about lifetime history of sexually transmitted diseases was collected as part of a medical status examination when participants were approximately 41 years old.

Results. Childhood sexual abuse increased risk for any sexually transmitted disease (odds ratio [OR] = 1.94; 95% confidence interval [CI] = 1.00, 3.77; P = .05) and more than 1 type of sexually transmitted disease (OR = 3.33; 95% CI = 1.33, 8.22; P = .01). Physical abuse increased risk for more than 1 type of sexually transmitted disease (OR = 3.61; 95% CI = 1.39, 9.38; P = .009).

Conclusions. Our results provided the first prospective evidence that child physical and sexual abuse increases risk for sexually transmitted diseases. Early screening and interventions are needed to identify and prevent sexually transmitted diseases among child abuse victims.

Many studies have called attention to long-term health consequences associated with child abuse and neglect.^1–3 Cross-sectional studies have described associations between self-reports of childhood abuse and a reported history^4–15 or biological markers^16,17 of sexually transmitted diseases (STDs) among adolescents or adults. Victims of child maltreatment may be at increased risk for STDs because of several factors: (1) direct exposure through child sexual abuse^18–20; (2) increased rates of risky sexual behavior among victims of sexual abuse^{1,4–6,13,14,21–26} and nonsexual forms of child maltreatment^1,22,27–30; (3) earlier initiation of sexual activity,^9,28,31,32 which is associated with increased risk for STDs^33,34; and (4) sexual activity with riskier partners.⁸ However, not all studies have supported this relationship.^35–38

We examined rates of STDs in a large sample of individuals with documented cases of childhood sexual abuse, physical abuse, or neglect and a matched control group followed up prospectively into adulthood (when participants were approximately 41 years old). We tested the hypothesis that victims of child abuse and neglect have a higher lifetime prevalence of STDs than do nonvictims.

METHODS

Design and Participants

Data were collected as part of a large prospective cohort study in which abused or neglected children were matched with children who were not maltreated, and both groups were followed into adulthood. Because of the matching procedure, the participants were assumed to differ only in the risk factor (childhood abuse or neglect). Because it was not possible to assign participants randomly to groups, the assumption of equivalency for the groups was an approximation. The control group might also have differed from the abused and neglected participants on other variables associated with abuse or neglect. Complete details of the study design and participant selection criteria are available elsewhere.³⁹

The original sample of 908 abused or neglected children comprised all substantiated cases of child physical and sexual abuse and neglect processed from 1967 to 1971 in the county juvenile (family) or adult criminal courts of a midwestern metropolitan area. Cases of abuse and neglect were restricted to children 11 years or younger at the time of the incident and therefore represented child maltreatment. A control group of 667 children without documented histories of childhood abuse or neglect was matched with the abuse and neglect group. Children who were younger than school age at the time of the abuse or neglect were matched with children of the same gender, race, date of birth (±1 week), and hospital of birth through county birth records. For school-aged children, records of more than 100 elementary schools for the same period were used to find matches with children of the same gender, race, date of birth (±6 months), and class in elementary school during 1967 to 1971 and a similar home address, preferably within a 5-block radius of the abused or neglected child.

Matches were found for 74% of the abused or neglected children. Nonmatches occurred for several reasons. For birth records, nonmatches occurred when the abused or neglected child was born outside the county or state or when date of birth was missing. For school records, nonmatches resulted from inadequate identifying information for an abused or neglected child or because the elementary school had closed and class registers were unavailable. Reanalyses of findings on criminal behavior were conducted only on matched pairs, and the results did not change with the smaller sample size.⁴⁰ In our sample, there were no significant differences between the control group and the abuse and neglect group in the characteristics used for matching: gender (χ² = 1.44; P = .23), race (χ² = 0.001; P = .98), or age (F-statistic = 0.18; P = .67).

The initial phase of the study compared the abused or neglected children to the matched comparison group (n = 1575) on criminal arrest records.⁴⁰ A second phase involved tracking, locating, and interviewing both study groups during 1989 to 1995, approximately 20 years after the incidents of abuse and neglect. Of the original sample, 1307 participants (83%) were located and 1196 (76%) participated in the first follow-up interview. Subsequent follow-up interviews were conducted in 2000 to 2002 (n = 896, 75% of the first interview sample) and again in 2003 to 2004 (n = 807, 67% of the first interview sample). For the present study we used information gathered as part of a medical status examination conducted in 2003 to 2004 that included physical tests and a comprehensive health interview. Table 1 describes the reasons for attrition and the demographic characteristics of the 1989 to 1995 and 2003 to 2004 interview respondents.

TABLE 1.

Rates of Attrition and Demographic Characteristics of Sample at Each Stage of Data Collection

	1989–1995 (n = 1196)	2003–2004 (n = 807)
Base sample,a no.	1575b	1196
Reasons for attrition, % (no.)
Unable to locate	17.0 (268)	12.1 (145)
Deceased	2.7 (43)	3.9 (47)
Incapable of being interviewed (e.g., mental or physical impairment)	0.5 (8)	0.5 (6)
Refused to participate	3.8 (60)	15.9 (190)
Unusable data		<0.1 (1)
Demographic characteristics
Age, y, mean (range)	29.2 (19.0–40.7)	41.2 (32.0–49.0)
Female, % (no.)	48.7 (582)	52.8 (426)
Race/ethnicity, % (no.)
White, non-Hispanic	61.5 (735)	59.2 (478)
Black, non-Hispanic	32.5 (389)	34.2 (276)
Hispanic or other	6.0 (72)	6.6 (53)
High school graduate	56.3 (674)	58.9 (475)
Work, % (no.)
Menial/unskilled/semiskilled	53.6 (641)	54.6 (441)
Professional/semiprofessional	12.7 (153)	13.3 (108)

^aUsed to calculate attrition.

^bOriginal sample.

Because of racial/ethnic differences in rates of STDs^41,42 and because the sample comprised primarily non-Hispanic Whites and Blacks, analyses were restricted to these groups. Participants of other ethnic backgrounds (6.6% of the available sample) were dropped from our analyses, resulting in a total sample of 754 participants (63% of the original interview sample; 48% of the original archival sample). Whites were overrepresented among those not included (χ² = 8.98; P ≤ .01), but this comparison may be inaccurate because race in the original sample was extracted from court records and did not necessarily match participants’ self-report of race/ethnicity during the first interview. Nonetheless, race was controlled in analyses. Our sample did not differ significantly from those in the original sample who were not included, in age at original data collection (F = 0.17; P = .68), gender (χ² = 3.15; P = .08), or percentage of abuse and neglect cases (χ² = 1.42; P = .23).

Among members of our final sample, the average age was 41.2 years (range: 32.0–49.0 years), 52.9% were female, 63.4% were non-Hispanic White, and 36.6% were non-Hispanic Black. The sample was skewed toward the lower end of the socioeconomic spectrum; 60% of these respondents completed high school, 54.9% held unskilled or semiskilled jobs, and only 13.7% held semiprofessional or professional jobs.⁴³ The sample included 423 members of the abuse and neglect group (56.1%), representing 56 cases of sexual abuse (7.4%), 72 cases of physical abuse (9.5%), 344 cases of neglect (45.6%), and 331 matched controls.

Procedures

Participants completed the assessment in their homes or another appropriate place, if preferred by the participant. The interviewers were blind to the purpose of the study and to the inclusion of an abuse and neglect group. Participants were also blind to the purpose of the study and were told that they had been selected to participate as part of a large group of individuals who grew up in the late 1960s and early 1970s.

Measures

Child abuse and neglect.

Child physical and sexual abuse and neglect were assessed through review of official records processed during 1967 to 1971. Physical abuse cases included injuries such as bruises, welts, burns, abrasions, lacerations, wounds, cuts, bone and skull fractures, and other evidence of physical injury. Sexual abuse cases had charges ranging from the relatively nonspecific “assault and battery with intent to gratify sexual desires” to “fondling or touching in an obscene manner,” sodomy, incest, rape, and other offences. Neglect cases reflected a judgment that the parents’ deficiencies in child care were beyond those found acceptable by community and professional standards at the time and represented extreme failure to provide adequate food, clothing, shelter, and medical attention to children. Some individuals had experienced more than 1 type of child abuse or neglect.

Sexually transmitted diseases.

As part of the medical history interview during 2003 to 2004, participants were asked if they had ever been told by a doctor or other health care professional that they had genital herpes, syphilis, genital warts or human papillomavirus (HPV), gonorrhea, or chlamydia. Dichotomous (1 = yes and 0 = no) variables were created to reflect whether the respondent ever had (lifetime) (1) any STD, (2) more than 1 type of STD, and (3) each specific STD.

Analyses

Cross-tabulations and logistic regressions were conducted with SPSS 15.0 (SPSS Inc, Chicago, IL) to assess differences between the abuse and neglect and control groups for each outcome. Odds ratios (ORs) were generated by exponentiation of the regression coefficients and indicated magnitude of effect. ORs represented the change in likelihood of the outcome based on the value of the independent variable (e.g., abuse and neglect versus control group). To indicate statistical significance, 95% confidence intervals (CIs) and P values were reported; P ≤ .05 was considered statistically significant. Separate analyses examined gender by abuse and neglect and race by abuse and neglect interactions.

RESULTS

Lifetime Prevalence of Sexually Transmitted Infections

In the overall sample, 21.7% of participants reported having had at least 1 STD, and 7.7% reported more than 1 type of STD. The prevalence of specific STDs was 3.2% for genital herpes, 2.9% for syphilis, 3.6% for HPV, 11.6% for gonorrhea, and 9.8% for chlamydia.

Overall, women and men did not differ significantly in their likelihood of reporting a history of any STD (OR = 1.33; 95% CI = 0.94, 1.90; P = .11) or more than 1 type (OR = 1.34; 95% CI = 0.77, 2.33; P = .29). Black participants were more likely than were Whites to report any STD (OR = 3.40; 95% CI = 2.37, 4.88; P < .001) and to report more than 1 type (OR = 4.18; 95% CI = 2.34, 7.46; P < .001). Therefore, race (but not gender) was controlled in subsequent analyses; reported ORs were adjusted for variance in the outcomes accounted for by race.

Childhood Abuse and Neglect and Risk for Sexually Transmitted Infections

As shown in Table 2, being abused or neglected was associated with an increase in risk for reporting more than 1 type of STD (OR = 1.99; 95% CI = 1.10, 3.62; P = .02), compared with controls, although abused or neglected individuals did not differ as a group from controls in having had any STD. Victims of child sexual abuse were more likely than were controls to report any history of STDs (OR = 1.94; 95% CI = 1.00, 3.77; P = .05) and more than 1 type of STD (OR = 3.33; 95% CI = 1.33, 8.22; P = .01). Victims of child physical abuse were also at increased risk for more than 1 type of STD (OR = 3.61; 95% CI = 1.39, 9.38; P = .009) but not for having had any STD. Childhood neglect was not significantly associated with increased risk for STDs.

TABLE 2.

Lifetime Prevalence of Sexually Transmitted Diseases (STDs) Among Abused and Neglected Children and Matched Controls Followed Up to Approximately 41 Years of Age: 1967–1971 and 2003–2004

		Abuse and Neglect (n = 420)		Sexual Abuse (n = 55)		Physical Abuse (n = 72)		Neglect (n = 342)
Outcome	Control (n = 328), %	%	OR (95% CI)	%	OR (95% CI)	%	OR (95% CI)	%	OR (95% CI)
Any STD	19.5	23.4	1.28 (0.88, 1.84)	31.5	1.94* (1.00, 3.77)	19.7	1.32 (0.67, 2.61)	23.6	1.19 (0.81, 1.75)
> 1 Type of STD	5.2	9.7	1.99* (1.10, 3.62)	15.1	3.33** (1.33, 8.22)	11.4	3.61** (1.39, 9.38)	8.3	1.63 (0.86, 3.09)
Genital herpes	2.4	3.8	1.58 (0.67, 3.75)	3.6	1.49 (0.31, 7.25)	5.6	2.98 (0.84, 10.56)	3.5	1.44 (0.58, 3.58)
Syphilis	1.8	3.8	2.15 (0.83, 5.60)	7.4	4.27* (1.15, 15.91)	4.2	2.89 (0.68, 12.24)	3.8	2.09 (0.78, 5.61)
HPV	3.0	4.1	1.35 (0.61, 3.00)	9.3	3.24* (1.06, 9.87)	1.4	0.47 (0.06, 3.72)	3.2	1.07 (0.45, 2.55)
Gonorrhea	9.8	13.0	1.41 (0.87, 2.82)	15.1	1.68 (0.70, 4.01)	11.3	1.78 (0.73, 4.33)	12.4	1.29 (0.78, 2.15)
Chlamydia	9.1	10.3	1.14 (0.69, 1.89)	13.0	1.50 (0.61, 3.67)	8.5	1.22 (0.47, 3.15)	10.0	1.07 (0.63, 1.82)

Note. OR = odds ratio; CI = confidence interval; HPV = human papillomavirus. Exact sample sizes differed slightly for each analysis because of missing data on particular items. Sample sizes for the different types of abuse and neglect sum to more than 420 because some respondents had more than 1 type. Statistical comparisons were between the abuse and neglect groups and the control group, with control for race.

*P ≤ .05; **P ≤ .01.

Specific sexually transmitted diseases.

Table 2 also shows that individuals with documented cases of childhood sexual abuse were at increased risk for syphilis (OR = 4.27; 95% CI = 1.15, 15.91; P = .03) and HPV (OR = 3.24; 95% CI = 1.06, 9.87; P = .04). Overall, childhood abuse or neglect did not significantly increase risk for other specific STDs.

Gender differences.

Table 3 shows rates of STDs separately for men and women in the abuse and neglect and control groups. Among women in the sample, childhood sexual abuse was associated with increased risk for more than 1 type of STD (16.3% versus 5.4%; OR = 3.87; 95% CI = 1.38, 10.85; P = .01), syphilis (6.7% versus 0.6%; OR = 11.62; 95% CI = 1.18, 114.74; P = .04), and gonorrhea (18.2% versus 7.2%; OR = 2.93; 95% CI = 1.07, 8.04; P = .04). Physical abuse and neglect did not significantly increase risk for STDs among women. Childhood abuse or neglect was not associated with increased risk for STDs among men (Table 3). We also tested a series of gender by abuse and neglect interactions predicting history of STDs, but none was significant.

TABLE 3.

Gender Differences in Lifetime Prevalence of Sexually Transmitted Diseases (STDs) Among Abused and Neglected Children and Matched Controls Followed Up to Approximately 41 Years of Age: 1967–1971 and 2003–2004

	Women, %					Men, %
Outcome	Control (n = 166)	Abuse and Neglect (n = 231)	Sexual Abuse (n = 45)	Physical Abuse (n = 34)	Neglect (n = 183)	Control (n = 162)	Abuse and Neglect (n = 189)	Sexual Abuse (n = 10)	Physical Abuse (n = 38)	Neglect (n = 159)
Any STD	20.5	26.5	33.3	18.2	25.3	18.5	19.7	22.2	21.1	19.5
> 1 Type of STD	5.4	10.6	16.3**	9.4	9.4	4.9	8.0	0.0	10.8	6.9
Genital Herpes	3.6	4.3	4.4	5.9	4.4	1.2	3.2	0.0	5.3	2.5
Syphilis	0.6	3.0	6.7*	0.0	2.2	3.1	4.8	11.1	7.9	5.7
HPV	4.2	5.2	9.1	0.0	4.4	1.9	2.7	10.0	2.7	1.9
Gonorrhea	7.2	13.2	18.2*	12.1	12.2	12.3	12.8	0.0	10.5	12.6
Chlamydia	12.7	0.9	15.9	11.8	13.8	5.6	5.9	0.0	5.4	5.7

Note. HPV = human papillomavirus. Sample sizes differed slightly for each analysis because of missing data on particular items. Sample sizes for the different types of abuse and neglect summed to more than the total for any abuse or neglect because some respondents had more than 1 type. Statistical comparisons were between the abuse and neglect groups and the control group, with control for race.

*P ≤ .05; **P ≤ .01.

Race differences.

As shown in Table 4, childhood sexual abuse was associated with an increased risk for more than 1 type of STD among Whites (15.6% versus 1.4%; OR = 15.19; 95% CI = 3.59, 64.27; P < .001) but not among Blacks (10.0% versus 11.7%; OR = 0.84; 95% CI = 0.18, 4.02; P = .83). This interaction was statistically significant (OR = 0.06; 95% CI = 0.01, 0.47; P = .008).

TABLE 4.

Race Differences in Lifetime Prevalence of Sexually Transmitted Diseases (STDs) Among Abused and Neglected Children and Matched Controls Followed Up to Approximately 41 Years of Age: 1967–1971 and 2003–2004

	Blacks, %					Whites, %
Outcome	Control (n = 120)	Abuse and Neglect (n = 155)	Sexual Abuse (n = 21)	Physical Abuse (n = 15)	Neglect (n = 131)	Control (n = 208)	Abuse and Neglect (n = 263)	Sexual Abuse (n = 34)	Physical Abuse (n = 57)	Neglect (n = 211)
Any STD	34.2	36.1	42.9	40.0	35.1	11.1	16.0	24.2*	14.3	14.8
> 1 Type of STD	11.7	16.3	10.0	26.7	16.2	1.4	5.4*	15.6***	5.6*	3.3
Genital Herpes	5.0	3.2	0.0	6.7	3.1	1.0	4.2*	5.9	5.3	3.8
Syphilis	3.3	8.4	14.3*	6.7	8.4	1.0	1.1	3.0	3.6	1.0
HPV	3.3	1.9	9.5	0.0	0.8	2.9	5.3	9.1	1.8	4.7
Gonorrhea	20.8	24.8	20.0	33.3	24.6	3.4	6.1	12.1*	5.4	4.8
Chlamydia	17.5	18.2	15.0	20.0	18.3	4.3	5.7	11.8	5.4	4.8

Note. HPV = human papillomavirus. Sample sizes differed slightly for each analysis because of missing data on particular items. Sample sizes for the different types of abuse and neglect summed to more than the total for any abuse and neglect because some respondents had more than 1 type. Statistical comparisons were between the abuse and neglect groups and the control group.

*P ≤ .05; **P ≤ .01; ***P ≤ .001.

Among Whites (but not Blacks), childhood abuse and neglect significantly predicted risk for more than 1 type of STD (5.4% versus 1.4%; OR = 4.17; 95% CI = 1.19, 14.59; P = .03) and for herpes (4.2% versus 1.0%; OR = 4.46; 95% CI = 0.98, 20.35; P = .05). Childhood sexual abuse was associated with increased risk for any STD (24.2% versus 11.1%; OR = 2.57; 95% CI = 1.04, 6.37; P = .04) and gonorrhea (12.1% versus 3.4%; OR = 3.96; 95% CI = 1.09, 14.37; P = .04). Childhood physical abuse was associated with increased risk for more than 1 type of STD (5.6% versus 1.4%; OR = 5.36; 95% CI = 1.16, 24.70; P = .03; Table 4). A different pattern of results emerged for Blacks: only childhood sexual abuse predicted an increased risk for syphilis (14.3% versus 3.3%; OR = 4.83; 95% CI = 1.00, 23.40; P = .05). None of these racial differences yielded statistically significant interactions.

DISCUSSION

Thirty years later, victims of child sexual abuse were twice as likely as controls to report having had an STD and were more than 3 times as likely to report more than 1 type of STD. We also found that victims of child physical abuse were more likely than were controls to report more than 1 type of STD. These results are consistent with a trend found previously with this same sample indicating that victims of child abuse and neglect were twice as likely as controls to be HIV positive by middle adulthood, as shown by blood tests or self-reports.²⁸ Our previous findings regarding HIV, a disease with a very low base rate, did not reach statistical significance, but the more robust findings reported here strengthen support for the hypothesis that victims of child maltreatment are at risk for STDs. Our findings underscore the importance of examining relationships between nonsexual forms of childhood maltreatment and risk for STDs and suggest that victims of child physical, as well as sexual, abuse would benefit from early screening and interventions to identify and prevent STDs.

Our findings revealed gender and race differences in the relationship between childhood maltreatment and STD risk. History of childhood sexual abuse was associated with increased risk for STDs among women but not among men. The reason for this gender difference is unclear; we hypothesized that childhood abuse would increase risk for STDs in both men and women. One possibility is that childhood abuse increases risk behavior among both men and women, but increased risk for STDs is only apparent among women because of greater physiological vulnerability to STDs.^44,45 Moreover, our previous findings suggested that early sexual contact, which is associated with increased risk for STDs,^33,34 is more strongly associated with childhood abuse and neglect for women than it is for men.²⁸ The link between childhood abuse and STDs among women has important implications in light of recent evidence that one fourth of adolescent girls are infected with STDs.⁴⁶ Our findings suggest that the potential role of childhood abuse should be addressed in efforts to prevent and reduce STDs among young women.

Childhood sexual and physical abuse increased overall risk for STDs among Whites but not among Blacks. Again, it is unclear why the hypothesized relationship between childhood abuse and STDs was, in general, only corroborated for Whites. Our findings and national surveillance data⁴¹ reveal generally higher rates of STDs among Blacks than among other racial/ethnic groups. Thus, it is possible that our results stem from a saturation effect, whereby Blacks in general are at elevated risk for STDs, but childhood abuse does not add risk for this group. A recent study found that engagement in risk behaviors was associated with increased prevalence of STDs among Whites but not among Blacks, who had higher rates regardless of their level of risk behavior.⁴⁷ The authors concluded that factors other than risk behavior accounted for racial disparities in rates of STDs and hypothesized that differences in sexual partnerships might explain this phenomenon. Some research suggests that Blacks are more likely than are Whites to choose partners whose risk levels differ from their own.⁴² Thus, Blacks who have relatively low risk may be more likely than their White counterparts to contract an STD through sexual intercourse with a high-risk partner. However, this explanation does not entirely or adequately clarify the race differences we found, especially because for some STDs (genital herpes and HPV), Blacks did not report a higher prevalence.

Syphilis represents 1 notable exception: in contrast with the general pattern of results, childhood abuse increased risk among Blacks rather than Whites. Although syphilis remains rare, previous declines in rates of infection appear to have reversed in recent years, making it an increasingly significant public health concern.^41,48 Our findings suggest that current public health efforts to eliminate syphilis from the US population⁴⁹ might focus on victims of child sexual abuse as a high-risk group. Moreover, women and Blacks with histories of childhood sexual abuse may be particularly at risk for syphilis.

Comparing rates of STDs among participants in our study to national prevalence estimates is difficult. The most reliable estimates are from surveillance of new cases of STDs reported to public health departments, but only chlamydia, gonorrhea, and syphilis are monitored through national surveillance, and those estimates do not reflect lifetime rates of STDs among individuals. Recent reports indicate that more than 50% of Americans are diagnosed with an STD in their lifetimes,⁵⁰ but this estimate reflects the currently high rate of HPV,⁵¹ which was relatively low in our sample.

In our sample of adults approximately 41 years old, 2.3% reported treatment of an STD in the past year, a prevalence rate similar to the 3% rate reported by a nationally representative sample of 15- to 44-year-olds.⁵² However, rates of STDs decline with age and are generally rare in middle adulthood.⁴¹ Therefore, it is possible that higher-than-average rates of STDs in our sample overall reduced differences between the abuse and neglect group and the control groups. It is also likely that self-reports resulted in underrepresentation of the true rate of STDs in this sample, because some individuals may not have known that they had an STD, may not have been routinely tested for certain STDs (e.g., HPV), or may have chosen not to report having had one. In general, face-to-face interviews yield lower reports of sensitive information than do self- or computer-administered interviews, but it is unclear which reports are most accurate.⁵³

Strengths and Limitations

Our study had several advantages: (1) a prospective matched cohort design providing an appropriate comparison group and assessment of the correct temporal sequence of events, (2) assessment of outcomes beyond adolescence and young adulthood, (3) a large heterogeneous sample that included men and women and Blacks and Whites, (4) inclusion of nonsexual forms of child maltreatment, (5) unambiguous definitions of child abuse and neglect, and (6) documented cases of child maltreatment.

Despite its strengths, several limitations of this study must be noted. First, although official maltreatment records yield more-accurate data than do retrospective self-reports, cases of abuse and neglect that did not come to the attention of authorities were not included. Thus, it is possible that the control group included individuals with childhood abuse or neglect histories that were not reported or did not meet the threshold for substantiation. Second, history of STDs was self-reported by participants and thus was subject to various recall and self-report biases. However, biological tests would only identify currently infected individuals; our participants’ responses reflected lifetime prevalence of STDs. In addition, self-report data did not include the number of times individuals were diagnosed with STDs. Third, the socioeconomic status of our sample was skewed toward the lower end of the socioeconomic spectrum, and therefore, results cannot be generalized to cases of child abuse and neglect in middle-class samples. Fourth, our study focused on child abuse (before age 12) and therefore did not reflect consequences associated with abuse during adolescence. Finally, because the likelihood of committing a type 1 error increases with the number of statistical tests conducted, it is possible that 1 or more of the reported findings resulted from chance.

Conclusions

Our findings provide the first prospective evidence that child physical and sexual abuse leads to an increased risk for STDs. Further research is needed to understand the mechanisms whereby sexually and physically abused children become at risk for STDs. Longitudinal studies with younger cohorts of abused and neglected children might examine some of the issues raised by our results. Our findings contribute to a growing body of literature that recognizes child abuse as a risk factor for later health consequences and indicate that gender and race differences should be considered in these relationships.