Overall, 446 subjects were recruited from the public STD clinics and 279 students were recruited from the university. STD clinic patients were 57% male, median age 24, 30% non- Hispanic White, 51% non-Hispanic Black, and 19% Latino/Hispanic of any race. Students were 54% female, median age of 19, 32% Hispanic/Latino, 26% Non- Hispanic Black, 22% Non-Hispanic White, and 18% Asian.

Twelve codes emerged from the dataset in roughly two major content areas: seeking information about STDs using general terms (including prevention, testing and treatment) and accessing information based on symptoms (Table 1). One code “sex education” was only applied to the student excerpts. The term “education” occurred in 11% of the student excerpts and none of the clinic excerpts.

Table 1 Search term codes and quotes from STD clinic and student sample. Full size table

The clinic sample length of query ranged from 4 to 230 characters, with a median of 50 characters; the student sample ranged from 4 to 116 characters with a median of 41. The average English language query on Google is estimated at 20 characters or approximately 4–5 words17,18, thus our participants reported longer than average search queries. There were no demographic differences detected in the student sample in regard to length of query, however, in the clinic sample all respondents who reported queries over 150 characters were also Non-Hispanic Black.

Nearly half (47%) of the clinic sample reported using the search term “STD Symptoms” compared to 17% of the student sample (p < 0.01; Fig. 1). In addition, clinic participants were significantly more likely than student participants to report describing STD-related symptoms, or searching using words related to treatment and testing. Student participants were significantly more likely than the clinic sample to report general terms, using “STD” as their only search term (26% vs. 8%; p < 0.01) or searching for general STD information (26% vs. 6%, p < 0.01). The clinic sample was more likely to report seeking information based on symptoms, reflected in codes for describing symptoms and using the phrase ‘‘STD symptoms’’, compared to the student sample, which was more likely to search for general information.

Figure 1 Frequency of qualitative code occurrence applied to STD-related search content in STD clinic (N = 446) and student (N = 279) samples. (*p < 0.05, **p < 0.01). Full size image

The top 5 codes that exceeded the 10% threshold are presented in Table 2 for the clinic participants and Table 3 for the student participants. The top codes for the clinic participants were codes that encompassed describing STD symptoms, using STD disease names, using the phrase “STD symptoms”, searching for STD testing information and/or searching for STD treatment. The top codes for the student participants were codes that encompassed searching for STD information, using the term “STD” as the only search term, using the phrase “STD symptoms”, searching for sexual education and/or searching using STD names. Two of the content areas using “STD symptoms” and searching using STD names were found in both the clinic and student samples among the top reported search queries.

Table 2 Top qualitative codes by clinic sample characteristics. Full size table

Table 3 Top qualitative codes by student sample characteristics. Full size table

In the clinic sample, females were more likely to report describing specific STD-related symptoms than were males (p = 0.04; Table 2). In addition, Non-Hispanic Blacks (22%) were more likely than both Non-Hispanic Whites (11%) and Hispanic/Latinos of any race (12%) to report searching for STD information by describing symptoms (p = 0.01). Those who were Hispanic/Latino were more likely to report using the search term STD symptoms compared to other races (p = 0.04). Those who were 25–29 years old were more likely to use the STD disease name in their search compared to any other age category (p = 0.01). Finally, those who used condoms were more likely than those who did not use condoms to report searching for STD test information (22% vs.14%, p = 0.02).

In the student sample, there were no differences in occurrence of the codes by race or sex (Table 3). Compared to other age groups, those who were older (25–29 years old) were more likely to report they searched using the term “STD Symptoms” (p = 0.01) or that they only used the term “STD” (p = 0.04). In terms of sexual behavior, men who have sex with women (MSW) were the most likely to report searching for STD information by typing “STD symptoms” (p = 0.04), there were no other differences in code occurrence by sexual behavior. Those who reported having a previous STD were more likely to search using a disease name (p = 0.05). Finally, those with zero sex partners in the past 6 months, were more likely to report searching for general STD information (p = 0.02).

Results of Triangulation

Nine of the 11 codes applied to the clinic sample had no statistically significant relationship with the quantitative question and 9 of the 12 codes applied to the student sample had no statistically significant relationship. In the clinic sample, the code encompassing specific sexually transmitted disease name was associated with selecting “yes” to the response reflecting searching the Internet to learn more (p = 0.01). The codes reflecting searches related to transmission and prevention of STDs were associated with selecting “yes” to the response reflecting searching to learn how to treat an STD and how to prevent an STD (p = 0.01 and p = 0.03, respectively). In the student sample, the code for description of specific STD-related symptoms was related to selecting “yes” on the responses related to searching because you think you have a STD and for treatment information (Fisher’s exact p = 0.04; p = 0.02). The code for searches for STD test information was associated with selecting “yes” on the response related to searching to find a place to get tested (p = 0.02) and the code for searching for STD treatment was associated with selecting “yes” on the response related to searching to learn how to treat an STD (p = 0.01).

Results of Google Correlate analysis

The direct term “STD symptoms” was reported by 47% of the clinic sample and 17% of the student sample. When entered into Google Correlate, the term “STD symptoms” generated many STD-related terms with high levels of correlation (0.87–0.94). The top 20 terms that were associated with “STD symptoms” are displayed in Table 4. Five of the twenty terms are not directly related to STDs (“how to talk to women”, “estrogen pills”, “pregnant symptoms” “talk to women” and “first trimester symptoms”). As disease name was often stated as a term used in searching for STD information (19% clinic; 13% student), “Chlamydia” was entered into Google Correlate. Sixteen of the top 20 search terms that were correlated with “STD symptoms” were also highly correlated with “Chlamydia.” Two of the terms that were generated by “STD symptoms” and not directly related to STDs (“how to talk to women”, “first trimester symptoms”) were not correlated with the search term “Chlamydia.” Search terms related to STD test, discharge (“thick discharge” “white discharge” “creamy discharge”), “STD” or STD treatment had few terms correlated that were related to STD information. For example, the term “STD” generated “gonorrhea” as the third highest correlated term at 0.924, however all of the other top 20 terms were unassociated with STDs. In addition, participant-generated search terms related to “sex education” and using the phrase “sexually transmitted infection” did not result in any Google correlated STD-related terms.