Intimately Sent Infections Among Women That Have Intercourse With Females

Intimately Sent Infections Among Women That Have Intercourse With Females

Linda M. Gorgos, Jeanne M. Marrazzo, intimately sent Infections Among ladies Who Have Sex With Women, Clinical Infectious conditions, Volume 53, problem suppl_3, 15 2011, Pages S84–S91, https: // december


Ladies who have sexual intercourse with ladies (WSW) are really a group that is diverse variations in intimate identity, intimate actions, intimate techniques, and danger actions. WSW are in danger of acquiring microbial, viral, and protozoal intimately sent infections (STIs) from present and partners that are prior both male and female. Bacterial vaginosis is common amongst feamales in basic and much more therefore among ladies with feminine lovers. WSW really should not be assumed become at low or no danger for STIs centered on intimate orientation, and reporting of same-sex behavior by females must not deter providers from considering and screening that is performing STIs, including chlamydia, within their customers in accordance with present tips. Effective distribution of intimate wellness solutions to WSW requires a thorough and discussion that is open of and behavioral dangers, beyond intimate identification, between care providers and their female customers.

In line with the 2002 nationwide Survey of Family development (NSFG), a nationally representative test of households in the us, 4.4% of females aged 15–44 years reported having a sex that is female in past times year and 1.3% reported having solely feminine intercourse lovers in past times year. Making use of measures of both self-reported identity that is intimate sexual behavior, it had been projected that 1.3percent–1.9% of US women can be lesbians and that 3.1%–4.8% are bisexual 1. Life time same-sex behavior is commonly reported by feamales in big population-based surveys, which range from 11.2per cent of females into the 2002 NSFG to 7.1% of females in nationwide health insurance and Nutrition Examination Survey (NHANES), 2001–2006 1, 2.

Although considerable data can be obtained regarding intimately transmitted infections (STIs) among males that have intercourse with guys, reasonably little was posted about STI prevalence and risks among other sexual and gender minorities, including ladies who have sexual intercourse with ladies (WSW). Healthcare providers and their feminine consumers would take advantage of increased familiarity with STI risks and guidance that is testing women that have actually same-sex lovers.


A systematic search of the literature on sexually transmitted infections in WSW was conducted using PubMed (National Library of Medicine) in October 2008 with subsequent updates through December 2010 in preparation for the 2010 update to the Centers for Disease Control and Prevention’s Sexually Transmitted Diseases (STD) Treatment Guidelines. MeSH (health topic Heading) terms and key words utilized included “lesbian, ” “women who possess intercourse with females, ” “homosexuality, female, ” “sexually transmitted disease, ” “gonorrhea, ” “chlamydia, ” “syphilis, ” “herpes simplex virus, ” “human papillomavirus, ” and “human immunodeficiency virus. ” Abstracts from major STD–related conferences at that time period 2005–2009 had been additionally searched utilizing the exact same search phrases and had been considered for inclusion. Writers of abstracts had been contacted to learn more if required. Key concerns had been developed considering summary of these sources as well as in assessment with specialists into the fields of infectious gender and disease minority wellness.

What exactly is Understood Concerning The Present Epidemiology of STIs Among WSW?

Chlamydia trachomatis and Neisseria gonorrhoeae infections among WSW happen considered unusual. Previous studies that included ladies from STD clinics and sexual wellness facilities reported a prevalence of chlamydial disease among WSW which range from 0.6per cent to 3.0per cent as well as gonorrhea from 0.3per cent to 2.8per cent 3–6. Nonetheless, no information on C. Trachomatis or N. Gonorrhoeae infections in WSW from community-based or venues that are population-based available. In 2008, Singh et al 7 examined chlamydia positivity among WSW aged 15–24 years tested at household preparation clinics taking part in the Infertility Prevention Project into the northwestern usa from 1997 to 2005. WSW and ladies who have intercourse with men and women (WSMW) into the one year ahead of screening had been included. Chlamydia positivity had been 7.1% among both WSW and WSMW and stayed stable on the amount of observation within the research. Chlamydia positivity throughout the time that is same for females reporting just male lovers within the year ahead of assessment ended up being 5.3%. Risks for chlamydial disease among WSW and WSMW were age 8, syphilis 9, and hepatitis A 10. Though it is presumably uncommon, intimate transmission of individual immunodeficiency virus (HIV) might also occur in this manner 11. Prior information suggesting prospective HIV transmission between feminine lovers is dependant on instance reports where assumed female-to-female transmission had been according to deficiencies in other identified danger factors 12–14. A study of 960 000 blood that is female neglected to recognize any HIV-infected ladies who identified same-sex contact as their sole risk element 15. Comparable outcomes had been noticed in a much smaller survey of lesbian and bisexual ladies 1
. A 2003 instance report is exclusive in distinguishing a female with no other reported risk that is behavioral HIV purchase apart from intimate connection with her sole feminine partner; she was discovered become recently contaminated with an identical HIV genotype to her understood HIV-infected feminine partner 11. More widespread may be the prospect of WSW to obtain HIV through other modes, including injection medication usage and intimate experience of high-risk male lovers 17–19.

Viral STIs including herpes virus kind 1 and 2 (HSV-1 and HSV-2) and individual papillomavirus (HPV) take place in WSW. Information through the 2002 NSFG were utilized to look at self-reported STIs that are viral ladies aged 15–44 years. A brief history of vaginal herpes or vaginal warts ended up being reported with greater regularity by bisexual females (15.0percent–17.2%) than by lesbians (2.3%–6.7%) and their heterosexual counterparts (8.7%–10.0%) 20.

A seroprevalence research of HSV in 392 WSW unearthed that 46% had antibodies to HSV-1 and 8% had antibodies to HSV-2. Increasing age had been predictive of higher seroprevalence of both HSV-1 and 2, and seropositivity that is HSV-2 connected with having a male partner with vaginal herpes. For the 78 feamales in the study reporting never ever having possessed a male partner, 3% were HSV-2 seropositive. HSV-1 seroprevalence increased with greater amounts of feminine lovers 21. In a different research of HSV-1 prevalence and purchase among ladies, receptive dental intercourse had been connected with HSV-1 purchase 22. More modern data from NHANES carried out in 2001–2006 among females aged 18–59 years demonstrated an HSV-2 seroprevalence of 30.3% among females reporting same-sex lovers into the year that is past 36.2% among ladies reporting same-sex lovers within their life time, and 23.8% among females reporting no life time same-sex behavior 2. HSV-2 seroprevalence among ladies self-identifying as homosexual or lesbian was 8.2%, comparable to a past study that is clinic-based of 2, 21. In addition, in a longitudinal research of HSV-2 purchase among ladies, the clear presence of microbial vaginosis (BV) had been connected with a heightened danger of acquiring HSV-2 (hazard ratio HR, 2.1 95% CI, 1.0–4.5; P =. 05). The calculated population attributable chance of BV for HSV-2 seroconversion had been 21% 23. Analyses of information from NHANES, 2001–2004, also discovered a connection between your existence of BV therefore the seroprevalence of HSV-2 and HSV-1 in women aged 20–44 years 24. There aren’t any posted studies to date to demonstrate in the event that remedy for BV could reduce acquisition of HSV-2 in women.

Genital HPV disease is typical, with particular HPV kinds associated with cervical cancer tumors. WSW had been when assumed become at low danger for HPV purchase and cancer that is cervical. Information now strongly help that HPV infections are typical among WSW and therefore sexual transmission of HPV likely happens between ladies 25–27. Prior case reports highlighted the existence of cervical neoplasia and HPV among females whom had no past reputation for intercourse with men 28, 29. HPV in WSW was examined utilizing both HPV serology and DNA detection practices. In a 1995 research, among WSW whom reported never ever having had a male intimate partner, 26% had antibodies to HPV-16 and 42percent had antibodies to HPV-6. No difference between the prevalence of HPV-16 and HPV-6 antibodies ended up being discovered between females with and females with out a past reputation for male lovers (P =. 16). HPV DNA had been detected in genital tract specimens in 30% of this ladies enrolled. The clear presence of HPV DNA had been connected with present cigarette smoking (chances ratio OR, 3.4 95% CI, 1.2–9.6) and a faster time since final intercourse with a partner that is maleP =. 002). The prevalence of squamous lesions that are intraepithelial Pap smear ended up being 4%, comparable to that present in heterosexual ladies 25. A subsequent bigger research once more revealed the high prevalence of HPV in WSW, with 13% having HPV DNA in vaginal tract specimens (74% of that have been oncogenic kinds) and 4.4% having either low-grade or high-grade squamous intraepithelial lesions 26.

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