Primary care physicians' understanding and counseling practices of sexually transmitted diseases: a cross-sectional study in Saudi Arabia.

Abstract

Sexually transmitted infections (STIs) remain a significant global health burden. In Saudi Arabia, limited awareness, stigma, and inconsistent provider competence impede effective prevention and counseling. This study aimed to assess primary care physicians' (PCPs) competence and physician perceived barriers (attitudes) in STI prevention and counseling across Saudi primary care. A cross-sectional survey was conducted from July 2024 to July 2025 among PCPs in Saudi Arabia. Data were collected using a validated, self-administered electronic questionnaire through social media and official email lists. The survey collected sociodemographic data, STI-related practices (including risk assessment, counseling, and testing), and perceived barriers to care. Practices were scored as continuous variables using a 5-point Likert scale (Never to Always), while perceived barriers were assessed across five domains using a 5-point Likert scale (Strongly Disagree to Strongly Agree) and subsequently dichotomized into 'high' or 'low' based on the median score. Descriptive statistics summarized responses, and non-parametric tests evaluated group differences. Multivariable logistic regression was used to identify factors associated with higher practice scores, while logisitc regression identified predictors of high perceived barriers. Both models included age, gender, years of experience, practice sector, and number of STI patient consultations as independant variables and confounders. A total of 133 physicians participated (55% male, 45% female); most were aged 36-45 years (40%) and practicing in primary healthcare centers (38%) or governmental hospitals (35%). Training in STI counseling was most often obtained during residency (38%), though 12% reported no formal training. Clinical exposure was limited, with 51% managing 1-5 STI cases in the past six months. Mean scores were 2.59 for risk assessment, 3.76 for counseling, 3.75 for testing, and 3.64 for attitudes. Multivariable analysis revealed that the absence of recent clinical exposure to STI cases (managing zero cases in the past 6 months) was significantly associated with a lower risk assessment (β = -0.888, p = 0.0031), testing (β = -0.951, p = 0.0024), and attitude scores (β = -0.281, p = 0.0319). Counseling scores were significantly higher among physicians with 16-20 years' experience (β = 1.333, p 0.0108). PCPs in Saudi Arabia demonstrate moderate STI-related competence, with gaps in risk assessment and pervasive barriers to counseling. Targeted continuing education, structured training in sexual health, and standardized screening protocols are needed to enhance STI prevention and care in primary care settings.