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Sexually transmitted infections (STI) are a significant health concern, with half of all new STI occurring among young people aged 15–24 years. The Public Health Agency of Canada (PHAC) and the Centers for Disease Control (CDC) recommend routine STI testing for all sexually active individuals under age 25. In Canada, university-aged individuals have the highest rates of STI. Prior to the study by Cragg et al., there have been limited data for this demographic. Other studies have investigated HIV testing in college students but not bacterial STI testing in Canada. It was evident from the investigation that PHAC recommendations are currently not being met in this demographic, as 66% of heterosexual maritime university students had never been tested for STI. A study hypothesis was generated and suggested many university students engaging in high-risk sexual behaviour are not being tested for STI. While it is appreciated that the population examined for the purpose of this study was “completely” heterosexual university students, I believe the exclusion of men who have sex with men (MSM) and bisexual students is a strong limitation. MSM and bisexual men are at greater risk for STI when compared to heterosexual populations. High-risk groups drive STI transmission, with men having sex with men being the largest single high-risk group in many countries. Of particular significance is the higher rates of STI in young MSM. By excluding those not “completely heterosexual”, 2240 students were not eligible to participate in the study. This exclusion may be viewed as offensive and discriminatory by some students and possibly affected the survey response rate. Ultimately, this reduced the sample size and greatly affected generalizability and validity of the study findings. Furthermore, including MSM and bisexual students would be more reflective of a true university population. The investigation was valuable, however, the findings could have been strengthened by broadening the inclusion criteria and offering participation to those students who identified as “not completely” heterosexual.

Inclusion of a broader range of sexual orientations to strengthen the validity and generalizability of findings