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Sexually Sent Infections Among Ladies Who 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 December 2011, Pages S84–S91, https: //


Ladies who have intercourse with ladies (WSW) certainly are a diverse team with variants in intimate identification, intimate habits, intimate methods, and danger actions. WSW are in threat of acquiring microbial, viral, and protozoal intimately transmitted 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 females with feminine lovers. WSW shouldn’t be assumed become at low or no danger for STIs centered on intimate orientation, and reporting of same-sex behavior by ladies must not deter providers from considering and doing assessment for STIs, including chlamydia, within their consumers based on present tips. Effective distribution of intimate wellness solutions to WSW requires a thorough and available conversation of intimate and behavioral dangers, beyond intimate identification, between care providers and their feminine consumers.

In line with the 2002 nationwide Survey of Family Growth (NSFG), a nationally representative test of households in america, 4.4% of females aged 15–44 years reported having a feminine intercourse partner within the previous year and 1.3% reported having solely feminine intercourse lovers into the previous year. Utilizing measures of both self-reported intimate identity and sexual behavior, it had been projected that 1.3percent–1.9% of US women can be lesbians and therefore 3.1%–4.8% are bisexual 1. Lifetime behavior that is same-sex commonly reported by ladies in big population-based studies, 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 substantial information can be found regarding intimately transmitted infections (STIs) among males that have intercourse with males, reasonably little was posted about STI prevalence and dangers among other sexual and gender minorities, including ladies who have intercourse with ladies (WSW). Medical care providers and their female consumers would take advantage of increased familiarity with STI risks and testing guidance for 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 (healthcare topic Heading) terms and key words utilized included “lesbian, ” “women who’ve 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 utilising the exact same search phrases and had been considered for inclusion. Writers of abstracts had been contacted to learn more if necessary. Key concerns were developed centered on post on these sources plus in assessment with experts in the areas of infectious illness and sex minority wellness.

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

Chlamydia trachomatis and Neisseria gonorrhoeae infections among WSW have now been considered unusual. Previous studies that included ladies from STD clinics and health that is sexual 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. But, no information on C. Trachomatis or N. Gonorrhoeae infections in WSW from community-based or population-based venues had been available. In 2008, Singh et that is al examined chlamydia positivity among WSW aged 15–24 years tested at household preparation clinics taking part in the Infertility Prevention Project into the northwestern united states of america from 1997 to 2005. WSW and ladies who have sexual intercourse with both women and men (WSMW) when you look at the one year just before evaluation had been included. Chlamydia positivity ended up being 7.1% among both WSW and WSMW and remained stable on the amount of observation within the research. Chlamydia positivity throughout the time that is same for ladies reporting just male lovers into the year just before screening had been 5.3%. Dangers for chlamydial disease among WSW and WSMW were age 8, syphilis 9, and hepatitis A 10. Even though it is presumably unusual, intimate transmission of human being immunodeficiency virus (HIV) could also take place in this manner 11. Prior information suggesting prospective HIV transmission between feminine lovers is dependant on situation reports where assumed transmission that is female-to-female centered on too little other identified danger factors 12–14. A study of 960 000 blood that is female neglected to determine any HIV-infected women that identified same-sex contact as his or her single risk element 15. Comparable outcomes had been observed in a much smaller survey of lesbian and women that are bisexual 1
. A 2003 instance report is unique in determining a female with no other reported behavioral danger for HIV purchase apart from intimate experience of her sole feminine partner; she had been discovered become recently contaminated with an identical HIV genotype to her understood HIV-infected feminine partner 11. More widespread may be the possibility of WSW to obtain HIV through other modes, including injection medication usage and intimate connection with high-risk male lovers 17–19.

Viral STIs including herpes virus kind 1 and 2 (HSV-1 and HSV-2) and papillomavirus that is humanHPV) take place in WSW. Information through the 2002 NSFG had been utilized to look at self-reported STIs that are viral females aged 15–44 years. A brief history of vaginal herpes or vaginal warts ended up being reported more often by bisexual females (15.0percent–17.2%) than by lesbians (2.3%–6.7%) and their counterparts that are heterosexual8.7%–10.0per cent) 20.

A seroprevalence research of HSV in 392 WSW discovered 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. Of this 78 ladies in the study reporting never ever having possessed a male partner, 3% had been 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 sex that is oral connected with HSV-1 purchase 22. More modern data from NHANES carried out in 2001–2006 among ladies aged 18–59 years demonstrated an HSV-2 seroprevalence of 30.3% among females reporting same-sex lovers within the previous 12 months, 36.2% among ladies reporting same-sex lovers within their life time, and 23.8% among ladies reporting no life time same-sex behavior 2. HSV-2 seroprevalence among ladies self-identifying as homosexual or lesbian was 8.2%, much like a past study that is clinic-based of 2, 21. The existence of microbial vaginosis (BV) had been connected with an elevated danger of acquiring HSV-2 (hazard ratio HR, 2.1 95% CI, 1.0–4.5 additionally, in a longitudinal research of HSV-2 purchase among ladies P =. 05). The population that is calculated chance of BV for HSV-2 seroconversion had been 21% 23. Analyses of information from NHANES, 2001–2004, also discovered a link amongst the existence of BV plus the seroprevalence of HSV-1 and HSV-2 in females aged 20–44 years 24. There are not any posted studies up to now 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 acquisition and cervical cancer tumors. Information now strongly help that HPV infections are normal among WSW and that sexual transmission of HPV likely happens between ladies 25–27. Prior situation reports highlighted the current presence of cervical neoplasia and HPV among women that had no reputation for intercourse with men 28, 29. HPV in WSW happens to be 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 found between females with and ladies with no past reputation for male lovers (P =. 16). HPV DNA ended up being detected in vaginal tract specimens in 30% regarding the females enrolled. The clear presence of HPV DNA had been related to present smoking cigarettes (chances ratio OR, 3.4 95% CI, 1.2–9.6) and a faster time since final sex by having a male partner (P =. 002). The prevalence of squamous lesions that are intraepithelial Pap smear had been 4%, just like that present in heterosexual females 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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