STI knowledge and risk behaviors among university students in northeastern Italy: the role of medical education and sexual experience.

Introduction: Sexually transmitted infections (STIs) represent a major public health concern among young adults, particularly university students. Despite high educational attainment, this population often shows important gaps in STI-related knowledge and inconsistencies between knowledge and preventive behaviors. Understanding how objective and self-perceived STI knowledge varies across educational backgrounds and sexual risk profiles is essential for designing effective, targeted prevention strategies. Methods: We conducted a cross-sectional survey among all students enrolled at the University of Verona (Italy) during the 2020-2021 academic year. An ad-hoc, anonymous online questionnaire assessed sociodemographic characteristics, STI-related knowledge, information sources, sexual behaviors, and self-perceived competence. Sexual exposure risk was classified into four profiles (minimal, low, medium, high) based on sexual activity status, age at sexual debut, and number of partners in the past 12 months. Multivariable logistic regression models examined factors associated with four outcomes: awareness of specific STIs, correct knowledge of preventive measures, and self-perceived knowledge about STI acquisition and transmission. Results: A total of 2,187 students were included (mean age 21.9 years; 76.2% female). Although all participants had heard of STIs, only 7.6% were aware of all infections considered. Consistent condom use was reported by 38.9% of sexually active students and was lowest among those with multiple partners. Medical students showed substantially higher objective and self-perceived knowledge across all domains, including a markedly increased likelihood of recognizing all STIs. Higher sexual risk profiles were also associated with better STI awareness and higher self-perceived knowledge. Age was positively associated with objective knowledge but not with self-perceived competence. Sex and sexual orientation were not independently associated with any knowledge outcomes. Discussion: STI-related knowledge among university students is strongly shaped by educational pathway and sexual experience. While medical students and sexually active individuals demonstrate greater awareness, substantial knowledge gaps and a disconnection between knowledge and protective behaviors persist, particularly regarding condom use. These findings highlight the need for comprehensive, university-wide sexual health interventions that address both knowledge and behavioral determinants to effectively reduce STI risk among young adults.