Current Infectious Disease Reports

, Volume 14, Issue 2, pp 204–211 | Cite as

Emerging Sexual Health Issues Among Women Who Have Sex with Women

Sexually Transmitted Diseases (L Bachmann, Section Editor)

Abstract

Women who have sex with women (WSW) comprise a diverse group of people who evidence a spectrum of sexual identity, sexual behaviors, sexual practices, and risk behaviors. WSW are at risk of acquiring a diversity of sexually transmitted infections (STIs) from current and prior partners, both male and female. Notably, human papillomavirus (HPV) is sexually transmitted between female partners, and Pap smear guidelines should be followed in this group. Bacterial vaginosis is common among WSW. WSW should not be presumed to be at low or no risk for STIs based on sexual orientation, and reporting of same sex behavior by women should not deter providers from considering and performing screening for STIs, including Chlamydia trachomatis, according to current guidelines. Effective delivery of sexual health services to WSW requires a comprehensive and open discussion of sexual and behavioral risks, beyond sexual identity, between care providers and their female clients.

Keywords

Sexually transmitted infections Sexually transmitted diseases Lesbian Homosexuality Bisexuality Women who have sex with women Vaginal health Vaginitis Bacterial vaginosis Trichomoniasis Syphilis Human papillomavirus Cervical neoplasia 

Notes

Disclosure

No potential conflicts of interest relevant to this article were reported.

References

Papers of particular interest, published recently, have been highlighted as:•• Of major importance

  1. 1.
    Mosher WD, Chandra JA, Jones J. Sexual behavior and selected health measures: men and women 15–44 years of age, United States. Hyattsville: National Center for Health Statistics 2005 Contract No.: 362; 2002.Google Scholar
  2. 2.
    •• Xu F, Sternberg MR, Markowitz LE. Women who have sex with women in the United States: prevalence, sexual behavior and prevalence of herpes simplex virus type 2 infection-results from national health and nutrition examination survey 2001–2006. Sex Transm Dis. 2010;37(7):407–13. This paper reports on one of the few nationally representative samples assessed for any sexually transmitted infection using a reliable biomarker among women who have sex with women.PubMedGoogle Scholar
  3. 3.
    Diamant AL, Schuster MA, McGuigan K, et al. Lesbians’ sexual history with men: implications for taking a sexual history. Arch Intern Med. 1999;159(22):2730–6.PubMedCrossRefGoogle Scholar
  4. 4.
    Koh AS, Gomez CA, Shade S, et al. Sexual risk factors among self-identified lesbians, bisexual women, and heterosexual women accessing primary care settings. Sex Transm Dis. 2005;32(9):563–9.PubMedCrossRefGoogle Scholar
  5. 5.
    Tao G. Sexual orientation and related viral sexually transmitted disease rates among US women aged 15 to 44 years. Am J Public Health. 2008;98(6):1007–9.PubMedCrossRefGoogle Scholar
  6. 6.
    Goodenow C, Szalacha LA, Robin LE, et al. Dimensions of sexual orientation and HIV-related risk among adolescent females: evidence from a statewide survey. Am J Public Health. 2008;98(6):1051–8.PubMedCrossRefGoogle Scholar
  7. 7.
    Bevier PJ, Chiasson MA, Heffernan RT, et al. Women at a sexually transmitted disease clinic who reported same-sex contact: their HIV seroprevalence and risk behaviors. Am J Public Health. 1995;85(10):1366–71.PubMedCrossRefGoogle Scholar
  8. 8.
    Scheer S, Peterson I, Page-Shafer K, et al. Sexual and drug use behavior among women who have sex with both women and men: results of a population-based survey. Am J Public Health. 2002;92(7):1110–2.PubMedCrossRefGoogle Scholar
  9. 9.
    Mercer CH, Bailey JV, Johnson AM, et al. Women who report having sex with women: British national probability data on prevalence, sexual behaviors, and health outcomes. Am J Public Health. 2007;97:1126–33.PubMedCrossRefGoogle Scholar
  10. 10.
    Eisenberg M. Differences in sexual risk behaviors between college students with same-sex and opposite-sex experience: results from a national survey. Arch Sex Behav. 2001;30(6):575–89.PubMedCrossRefGoogle Scholar
  11. 11.
    Lindley L, Burcin M. STD diagnoses among sexually active female college students: does sexual orientation or gender of sex partner(s) make a difference? Chicago: National STD Prevention Conference; 2008.Google Scholar
  12. 12.
    Austin SB, Roberts AL, Corliss HL, et al. Sexual violence victimization history and sexual risk indicators in a community-based urban cohort of “mostly heterosexual” and heterosexual young women. Am J Public Health. 2008;98(6):1015–20.PubMedCrossRefGoogle Scholar
  13. 13.
    Marrazzo JM, Koutsky LA, Kiviat NB, et al. Papanicolaou test screening and prevalence of genital human papillomavirus among women who have sex with women. Am J Public Health. 2001;91(6):947–52.PubMedCrossRefGoogle Scholar
  14. 14.
    Marrazzo JM, Koutsky LA, Stine KL, et al. Genital human papillomavirus infection in women who have sex with women. J Infect Dis. 1998;178(6):1604–9.PubMedCrossRefGoogle Scholar
  15. 15.
    Bailey JV, Kavanagh J, Owen C, et al. Lesbians and cervical screening. Br J Gen Pract. 2000;50(455):481–2.PubMedGoogle Scholar
  16. 16.
    Ferris DG, Batish S, Wright TC, et al. A neglected lesbian health concern: cervical neoplasia. J Fam Pract. 1996;43(6):581–4.PubMedGoogle Scholar
  17. 17.
    O’Hanlan K, Crum C. Human papillomavirus-associated cervical intraepithelial neoplasia following lesbian sex. Obstet Gynecol. 1996;88(4):702–3.PubMedCrossRefGoogle Scholar
  18. 18.
    Kerker B, Mostashari F, Thorpe L. Health care access and utilization among women who have sex with women: sexual behavior and identity. J Urban Health. 2006;83(5):970–9.PubMedCrossRefGoogle Scholar
  19. 19.
    Marrazzo JM, Stine K, Wald A. Prevalence and risk factors for infection with herpes simplex virus type-1 and -2 among lesbians. Sex Transm Dis. 2003;30(12):890–5.PubMedCrossRefGoogle Scholar
  20. 20.
    Cherpes TL, Meyn LA, Hillier SL. Cunnilingus and vaginal intercourse are risk factors for herpes simplex virus type 1 acquisition in women. Sex Transm Dis. 2005;32(2):84–9.PubMedCrossRefGoogle Scholar
  21. 21.
    Cherpes TL, Meyn LA, Krohn MA, et al. Association between acquisition of herpes simplex virus type 2 in women and bacterial vaginosis. Clin Infect Dis. 2003;37(3):319–25.PubMedCrossRefGoogle Scholar
  22. 22.
    Allsworth JE, Lewis VA, Peipert JF. Viral sexually transmitted infections and bacterial vaginosis: 2001–2004 national health and nutrition examination survey data. Sex Transm Dis. 2008;35(9):791–6.PubMedCrossRefGoogle Scholar
  23. 23.
    Skinner CJ, Stokes J, Kirlew Y, et al. A case-controlled study of the sexual health needs of lesbians. Genitourin Med. 1996;72(4):277–80.PubMedGoogle Scholar
  24. 24.
    Bailey JV, Farquhar C, Owen C, et al. Sexually transmitted infections in women who have sex with women. Sex Transm Infect. 2004;80(3):244–6.PubMedCrossRefGoogle Scholar
  25. 25.
    Edwards A, Thin RN. Sexually transmitted diseases in lesbians. Int J STD AIDS. 1990;1(3):178–81.PubMedGoogle Scholar
  26. 26.
    Fethers K, Marks C, Mindel A, et al. Sexually transmitted infections and risk behaviours in women who have sex with women. Sex Transm Infect. 2000;76(5):345–9.PubMedCrossRefGoogle Scholar
  27. 27.
    •• Singh D, Fine DN, Marrazzo JM. Chlamydia trachomatis infection among women reporting sexual activity with women screened in Family Planning Clinics in the Pacific Northwest, 1997 to 2005. Am J Public Health. 2011;101(7):1284–90. This is the first large analysis of chlamydia positivity in a well defined dataset used for chlamydia surveillance that allowed for an assessment of this infection among women who reported sex with other women, who had a surprsingly high burden of this disease.PubMedCrossRefGoogle Scholar
  28. 28.
    Kellock D, O’Mahony CP. Sexually acquired metronidazole-resistant trichomoniasis in a lesbian couple. Genitourin Med. 1996;72(1):60–1.PubMedGoogle Scholar
  29. 29.
    Campos-Outcalt D, Hurwitz S. Female-to-female transmission of syphilis: a case report. Sex Transm Dis. 2002;29(2):119–20.PubMedCrossRefGoogle Scholar
  30. 30.
    Walters MH, Rector WG. Sexual transmission of hepatitis a in lesbians. JAMA. 1986;256(5):594.PubMedCrossRefGoogle Scholar
  31. 31.
    Kwakwa HA, Ghobrial MW. Female-to-female transmission of human immunodeficiency virus. Clin Infect Dis. 2003;36(3):e40–1.PubMedCrossRefGoogle Scholar
  32. 32.
    Monzon OT, Capellan JM. Female-to-female transmission of HIV. Lancet. 1987;2(8549):40–1.PubMedCrossRefGoogle Scholar
  33. 33.
    Rich JD, Buck A, Tuomala RE, et al. Transmission of human immunodeficiency virus infection presumed to have occurred via female homosexual contact. Clin Infect Dis. 1993;17(6):1003–5.PubMedCrossRefGoogle Scholar
  34. 34.
    Sabatinti MT, Patel K, Hirschman R. Kaposi’s sarcoma and T-cell lymphoma in an immunodeficient woman: a case report. AIDS Res. 1983–1984;1(2):135–7.Google Scholar
  35. 35.
    Petersen LR, Doll L, White C, et al. No evdence for female-to-female HIV transmission among 960,000 female blood donors: the HIV blood donor study group. J Acquir Immune Defic Syndr. 1992;5(9):853–5.PubMedGoogle Scholar
  36. 36.
    Cohen H, Marmor M, Wolfe H, et al. Risk assessment of HIV transmision among lesbians. J Acquir Immune Defic Syndr. 1993;6(10):1173–4.PubMedGoogle Scholar
  37. 37.
    Shotsky WJ. Women who have sex with other women: HIV seroprevalence in New York State counseling and testing programs. Women Health. 1996;24(2):1–15.PubMedCrossRefGoogle Scholar
  38. 38.
    Lemp GF, Jones M, Kellogg TA, et al. HIV seroprevalence and risk behaviors among lesbians and bisexual women in San Francisco and Berkeley, California. Am J Public Health. 1995;85(11):1549–52.PubMedCrossRefGoogle Scholar
  39. 39.
    Martin HL, Richardson BA, Nyange PM, et al. Vaginal lactobacilli, microbial flora, and risk of human immunodeficiency virus type 1 and sexually transmitted disease acquisition. J Infect Dis. 1999;180(6):1863–8.PubMedCrossRefGoogle Scholar
  40. 40.
    Myer L, Kuhn L, Stein ZA, et al. Intravaginal practices, bacterial vaginosis, and women’s susceptibility to HIV infection: epidemiological evidence and biological mechanisms. Lancet Infect Dis. 2005;5(12):786–94.PubMedCrossRefGoogle Scholar
  41. 41.
    Myer L, Denny L, Telerant R, et al. Bacterial vaginosis and susceptibility to HIV infection in South African women: a nested case-control study. J Infect Dis. 2005;192(8):1372–80.PubMedCrossRefGoogle Scholar
  42. 42.
    Atashili J, Poole C, Ndumbe PM, et al. Bacterial vaginosis and HIV acquisition: a meta-analysis of published studies. AIDS. 2008;22(12):1493–501.PubMedCrossRefGoogle Scholar
  43. 43.
    Berger BJ, Kolton S, Zenilman JM, et al. Bacterial vaginosis in lesbians: a sexually transmitted disease. Clin Infect Dis. 1995;21(6):1402–5.PubMedCrossRefGoogle Scholar
  44. 44.
    McCaffrey M, Varney P, Evans B, et al. Bacterial vaginosis in lesbians: evidence for lack of sexual transmission. Int J STD AIDS. 1999;10(5):305–8.PubMedCrossRefGoogle Scholar
  45. 45.
    Bailey JV, Farquhar C, Owen C. Bacterial vaginosis in lesbians and bisexual women. Sex Transm Dis. 2004;31(11):691–4.PubMedCrossRefGoogle Scholar
  46. 46.
    Evans AL, Scally AJ, Wellard SJ, et al. Prevalence of bacterial vaginosis in lesbians and heterosexual women in a community setting. Sex Transm Infect. 2007;83(6):470–5.PubMedCrossRefGoogle Scholar
  47. 47.
    Koumans EH, Sternberg M, Bruce C, et al. The prevalence of bacterial vaginosis in the United States, 2001–2004; associations with symptoms, sexual behaviors, and reproductive health. Sex Transm Dis. 2007;34(11):864–9.PubMedCrossRefGoogle Scholar
  48. 48.
    Marrazzo JM, Koutsky LA, Eschenbach DA, et al. Characterization of vaginal flora and bacterial vaginosis in women who have sex with women. J Infect Dis. 2002;185(9):1307–13.PubMedCrossRefGoogle Scholar
  49. 49.
    Fethers KA, Fairley CK, Hocking JS, et al. Sexual risk factors and bacterial vaginosis: a systematic review and meta-analysis. Clin Infect Dis. 2008;47(11):1426–35.PubMedCrossRefGoogle Scholar
  50. 50.
    Marrazzo JM, Thomas KK, Agnew K, et al. Prevalence and risks for bacterial vaginosis in women who have sex with women. Sex Transm Dis. 2010;37(5):335–9.PubMedGoogle Scholar
  51. 51.
    •• Marrazzo JM, Thomas KK, Fiedler TL, et al. Risks for acquisition of bacterial vaginosis among women who report sex with women: a cohort study. PLoS One. 2010;5(6):e11139. This prospective stud of incident bacterial vaginosis demonstrated some risks that may be more prevalent among or unique to women who have sex with women, including having a recent sex partner with bacterial vaginosis and recent receptive oral sex.PubMedCrossRefGoogle Scholar
  52. 52.
    Oakley BB, Fiedler TL, Marrazzo JM, et al. Diversity of human vaginal bacterial communities and associations with clinically defined bacterial vaginosis. Appl Environ Microbiol. 2008;74(15):4898–909.PubMedCrossRefGoogle Scholar
  53. 53.
    Fredricks DN, Fiedler TL, Marrazzo JM. Molecular identification of bacteria associated with bacterial vaginosis. N Engl J Med. 2005;353(18):1899–911.PubMedCrossRefGoogle Scholar
  54. 54.
    Fredricks DN, Fiedler TL, Thomas KK, et al. Targeted PCR for detection of vaginal bacteria associated with bacterial vaginosis. J Clin Microbiol. 2007;45(10):3270–6.PubMedCrossRefGoogle Scholar
  55. 55.
    Marrazzo JM, Antonio M, Agnew K, et al. Distribution of genital lactobacillus strains shared by female sex partners. J Infect Dis. 2009;199(5):680–3.PubMedCrossRefGoogle Scholar
  56. 56.
    Hanson JM, McGregor JA, Hillier SL, et al. Metronidazole for bacterial vaginosis. A comparison of vaginal gel vs. oral therapy. J Reprod Med. 2000;45(11):889–96.PubMedGoogle Scholar
  57. 57.
    Hillier SL, Lipinski C, Briselden AM, et al. Efficacy of intravaginal 0.75% metronidazole gel for the treatment of bacterial vaginosis. Obstet Gynecol. 1993;81(6):963–7.PubMedGoogle Scholar
  58. 58.
    Livengood 3rd CH, McGregor JA, Soper DE, et al. Bacterial vaginosis: efficacy and safety of intravaginal metronidazole treatment. Am J Obstet Gynecol. 1994;170(3):759–64.PubMedGoogle Scholar
  59. 59.
    Bradshaw CS, Morton AN, Hocking J, et al. High recurrence rates of bacterial vaginosis over the course of 12 months after oral metronidazole therapy and factors associated with recurrence. J Infect Dis. 2006;193(11):1478–86.PubMedCrossRefGoogle Scholar
  60. 60.
    Sobel JD, Ferris D, Schwebke J, et al. Suppressive antibacterial therapy with 0.75% metronidazole vaginal gel to prevent recurrent bacterial vaginosis. Am J Obstet Gynecol. 2006;194(5):1283–9.PubMedCrossRefGoogle Scholar
  61. 61.
    Marrazzo JM, Thomas KK, Fiedler TL, et al. Relationship of specific vaginal bacteria and bacterial vaginosis treatment failure in women who have sex with women. Ann Intern Med. 2008;149(1):20–8.PubMedGoogle Scholar
  62. 62.
    Colli E, Landoni M, Parazzini F. Treatment of male partners and recurrence of bacterial vaginosis: a randomised trial. Genitourin Med. 1997;73(4):267–70.PubMedGoogle Scholar
  63. 63.
    Moi H, Erkkola R, Jerve F, et al. Should male consorts of women with bacterial vaginosis be treated? Genitourin Med. 1989;65(4):263–8.PubMedGoogle Scholar
  64. 64.
    Vejtorp M, Bollerup AC, Vejtorp L, et al. Bacterial vaginosis: a double-blind randomized trial of the effect of treatment of the sexual partner. Br J Obstet Gynaecol. 1988;95(9):920–6.PubMedCrossRefGoogle Scholar
  65. 65.
    Vutyavanich T, Pongsuthirak P, Vannareumol P, et al. A randomized double-blind trial of tinidazole treatment of the sexual partners of females with bacterial vaginosis. Obstet Gynecol. 1993;82(4 Pt 1):550–4.PubMedCrossRefGoogle Scholar
  66. 66.
    Gray RH, Kigozi G, Serwadda D, et al. The effects of male circumcision on female partners’ genital tract symptoms and vaginal infections in a randomized trial in Rakai, Uganda. Am J Obstet Gynecol. 2009;200(1):42.e1–e7.CrossRefGoogle Scholar
  67. 67.
    Marrazzo J, Thomas KK, Ringwood K. A behavioral intervention to reduce persistence of bacterial vaginosis among women who report sex with women: results of a randomized trial. Sex Transm Infect. 2011;87:399–405.PubMedCrossRefGoogle Scholar
  68. 68.
    Commitee on Lesbian Health Research Priorities IoM. In: Solarz A, editor. Lesbian health: current assessment and direction for the future. Washington DC: National Academy Press; 1999.Google Scholar

Copyright information

© Springer Science+Business Media, LLC 2012

Authors and Affiliations

  1. 1.Department of Medicine, Division of Allergy & Infectious DiseasesUniversity of WashingtonSeattleUSA
  2. 2.Infectious Disease Bureau, Public Health Division, New Mexico Department of HealthSanta FeUSA
  3. 3.Harborview Medical Center, Division of Infectious DiseasesSeattleUSA

Personalised recommendations