Delays in treatment seeking for sexually transmitted infections in India: A multicentric study of the care-seeking pathway

Sexually transmitted infections (STIs) remain a major public health concern; however, delayed treatment seeking shapes transmission dynamics and adverse reproductive health outcomes. Although delays are often attributed to behavioural inadequacies, social science research shows healthcare service use is influenced by gender-based power dynamics, economic status, and resource accessibility. This multicentric cross-sectional study examined social patterning of treatment-seeking delay among patients with STI symptoms across six sites in India. Of 3,158 participants recruited, 3,001 with complete symptom-onset data were included in delay-specific analyses. Delay from symptom onset to first healthcare consultation was categorised as no delay (≤ 7 days), moderate delay (8–30 days), and prolonged delay (> 30 days). Multinomial logistic regression assessed associations between delay and gender, residence, socioeconomic status, healthcare setting, and study site. Andersen’s Behavioral Model of Health Services Use guided the analysis, while participant-reported reasons for delay were organised by socio-ecological level to contextualize quantitative findings. Overall, 62.0% sought care after seven days, and 28.7% experienced prolonged delay, with a median of 105 days in this group. Delays occurred primarily before formal health-system entry; referral follow-up, diagnostics, and treatment initiation were timely once care was accessed. Prolonged delay was associated with female gender, rural residence, lower-middle socioeconomic status, tertiary-level facility attendance, and site variation. While symptom underestimation and self-medication were most commonly reported, mechanisms of delay varied across social groups, reflecting structural vulnerability and gendered constraints. These findings show STI treatment delay is socially structured rather than behavioral, highlighting the need for interventions addressing relational and structural barriers to timely care.