From Trauma to Transmission: The Long Shadow of Childhood Abuse on Sexually Transmitted Infections

Abstract

Childhood abuse is increasingly recognized as a critical early-life stressor with enduring consequences for adult health. Although prior research has linked childhood maltreatment to adverse sexual health outcomes, the mechanisms underlying these associations remain underexplored, particularly among general populations. This study aims to examine the long-term association between childhood emotional and physical abuse and the risk of sexually transmitted infections in adulthood, with a focus on two behavioral pathways: risky sexual behavior and early sexual onset. Data were drawn from the National Longitudinal Study of Adolescent to Adult Health, comprising a nationally representative sample of 4,859 respondents. A double machine learning approach was employed to estimate causal effects, leveraging machine learning to flexibly control for high-dimensional confounders and enhance the validity of mediation analysis. Findings revealed that individuals exposed to childhood abuse had significantly higher odds of sexually transmitted infection diagnosis in adulthood. Both risky sexual behavior and early sexual onset partially accounted for this association. This study advances conceptual and methodological understanding of the long-term consequences of childhood abuse on sexual health. Findings highlight the importance of trauma-informed and developmentally sensitive prevention strategies that address early adversity and behavioral risk pathways.