Publicado em: 07/08/20
Linda M. Gorgos, Jeanne M. Marrazzo, intimately Transmitted Infections Among ladies Who Have Sex With Women, Clinical Infectious conditions, Volume 53, problem suppl_3, 15 December 2011, Pages S84–S91, https: //doi.org/10.1093/cid/cir697
Ladies who have sexual intercourse with females (WSW) really are a diverse team with variants in intimate identification, intimate actions, intimate techniques, and danger habits. WSW have reached chance 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 ladies in basic and many more therefore among females with feminine lovers. WSW shouldn’t be presumed 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 doing assessment for STIs, including chlamydia, inside their customers in accordance with present recommendations. Effective distribution of intimate wellness services to WSW requires an extensive and discussion that is open of and behavioral dangers, beyond intimate identity, between care providers and their feminine consumers.
In line with the 2002 nationwide Survey of Family development (NSFG), a nationally representative test of households in america, 4.4% of females aged 15–44 years reported having a feminine intercourse partner in past times year and 1.3% reported having solely feminine intercourse lovers into the previous year. Utilizing measures of both self-reported intimate identification and sexual behavior, it had been projected that 1.3%–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 ladies in large population-based surveys, which range from 11.2percent of females within 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 obtained regarding intimately transmitted infections (STIs) among males that have intercourse with guys, fairly little was posted about STI prevalence and dangers among other sexual and gender minorities, including women that have sexual intercourse with ladies (WSW). Medical care providers and their feminine customers would reap the benefits of increased understanding of STI risks and guidance that is testing ladies who 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 heading that is subject 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 utilising the search that is same and had been considered for inclusion. Writers of abstracts had been contacted to find out more if required. Key concerns had been developed centered on post on these sources plus in assessment with professionals into the industries of infectious illness and sex minority wellness.
Chlamydia trachomatis and Neisseria gonorrhoeae infections among WSW have already 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 female muscle cam 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 within the northwestern united states of america from 1997 to 2005. WSW and women that have sexual intercourse with both women and men (WSMW) into the year just before screening had been included. Chlamydia positivity ended up being 7.1% among both WSW and WSMW and stayed stable throughout the amount of observation within the research. Chlamydia positivity throughout the time that is same for females reporting just male lovers within the one year ahead of assessment had been 5.3%. Dangers for chlamydial illness among WSW and WSMW were age 8, syphilis 9, and hepatitis A 10. Though it is presumably unusual, intimate transmission of peoples immunodeficiency virus (HIV) could also occur 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 deficiencies in other identified danger factors 12–14. A study of 960 000 feminine bloodstream donors neglected to determine any HIV-infected women that identified same-sex contact because their single risk element 15. Comparable outcomes had been present in a much smaller survey of lesbian and women that are bisexual 1
. A 2003 situation report is exclusive in determining a female with no other reported behavioral danger for HIV purchase apart from intimate connection with her sole feminine partner; she ended up being discovered become recently contaminated with the same HIV genotype to her understood HIV-infected feminine partner 11. More widespread could be the possibility of WSW to obtain HIV through other modes, including injection medication usage and intimate connection with high-risk male partners 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 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 counterparts that are heterosexual8.7%–10.0per cent) 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 HSV-2 seropositivity ended up being connected with having a male partner with vaginal herpes. Associated with the 78 feamales in the study reporting never ever having had a male partner, 3% had been HSV-2 seropositive. HSV-1 seroprevalence increased with higher variety of feminine lovers 21. In an independent research of HSV-1 prevalence and purchase among women, receptive sex that is oral connected with HSV-1 purchase 22. More modern data from NHANES conducted in 2001–2006 among females aged 18–59 years demonstrated an HSV-2 seroprevalence of 30.3% among ladies reporting same-sex lovers into the year that is past 36.2% among ladies reporting same-sex lovers inside their life time, and 23.8% among females reporting no life time same-sex behavior 2. HSV-2 seroprevalence among females self-identifying as homosexual or lesbian was 8.2%, much like a past clinic-based research of WSW 2, 21. In addition, in a longitudinal research of HSV-2 purchase among ladies, the clear presence of microbial vaginosis (BV) ended up being related to an elevated danger of acquiring HSV-2 (hazard ratio HR, 2.1 95% CI, 1.0–4.5; P =. 05). The population that is calculated chance of BV for HSV-2 seroconversion had been 21% 23. Analyses of data from NHANES, 2001–2004, also discovered a connection amongst the existence of BV while the seroprevalence of HSV-1 and HSV-2 in females aged 20–44 years 24. There aren’t any published studies up to now to show in the event that remedy for BV could reduce acquisition of HSV-2 in women.
Genital HPV illness 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 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 techniques. 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 vaginal tract specimens in 30% regarding the females enrolled. The clear presence of HPV DNA ended up being connected with present cigarette smoking (odds ratio OR, 3.4 95% CI, 1.2–9.6) and a reduced time since final intercourse by having a male partner (P =. 002). The prevalence of squamous lesions that are intraepithelial Pap smear ended up being 4%, just like that present in heterosexual females 25. A subsequent larger research once again revealed the prevalence that is high of 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.