Context: Recently, there has been a significant increase in STI rates across Canada. This trend is particularly evident in the young adult population, especially those attending university. This impacts university communities and places a significant burden on primary healthcare. Sexual health education has been shown to prevent negative sexual health outcomes and promote positive ones, but sexual health curricula differ between provinces and their implementation is inconsistent. Objective: To assess perceived and actual levels of student knowledge of sexual and reproductive health prior to and during university. Study Design: Mixed-methods study including qualitative (structured interview) and quantitative (survey) components. Survey incorporated semantic differential, Likert scale, dichotomous, and open-ended questions. Setting: St. Francis Xavier University, a small residential university in Nova Scotia, Canada. Outcome measures: Survey data were analyzed by t-test, Mann-Whitney U test, and ANOVA, as appropriate. A summary of interview responses is provided. Population studied: Students attending St. Francis Xavier University during 2019-2020. Results: Participants (n=350) reported general dissatisfaction with the quality of their sexual health education prior to university, rating it minimal to adequate. Current knowledge was generally rated as moderate. Knowledge about STI risk, transmission, safe sex practices, and treatment options varied with gender and degree program. Females had significantly higher perceptions of their current general STI knowledge compared to males (p=0.024), and their scores for general STI knowledge compared to males were also significantly higher (p=0.018), specifically those who have had 5-10 partners. Discussion: University students demonstrated deficient knowledge of types of STIs, their transmission, and symptoms. Many Canadian students rely on the sexual health education provided by their secondary schools; however, many Canadian educators do not receive formal training on the subject and the information provided may be inconsistent. Insufficient knowledge regarding sexual health combined with high-risk sexual practices prevalent in today’s culture likely contribute to the increased rates of STIs in this population. Based on these findings, it is recommended that a consistent delivery of education about safe sexual health practices be provided to students prior to and upon their arrival at university.