Chlamydia, Gonorrhea, and Human Immunodeficiency Virus Infection Among Transgender Women and Transgender Men Attending Clinics that Provide Sexually Transmitted Disease Services in Six US Cities: Results From the Sexually Transmitted Disease Surveillance Network

Abstract

Background Transgender women and transgender men are disproportionately affected by human immunodeficiency virus (HIV) infection and may be vulnerable to other sexually transmitted diseases (STDs), but the lack of surveillance data inclusive of gender identity hinders prevention and intervention strategies. Methods We analyzed data from 506 transgender women (1045 total visits) and 120 transgender men (209 total visits) who attended 26 publicly funded clinics that provide STD services in 6 US cities during a 3.5-year observation period. We used clinical and laboratory data to examine the proportion of transgender women and transgender men who tested positive for urogenital and extragenital chlamydial or gonococcal infections and who self-reported or tested positive for HIV infection during the observation period. Results Of the transgender women tested, 13.1% tested positive for chlamydia and 12.6% tested positive for gonorrhea at 1 or more anatomic sites, and 14.2% were HIV-infected. Of transgender men tested, 7.7% and 10.5% tested positive for chlamydia and gonorrhea at 1 or more anatomic sites, and 8.3% were HIV-infected. Most transgender women (86.0% and 80.9%, respectively) and more than a quarter of transgender men (28.6% and 28.6%, respectively) with an extragenital chlamydial or gonococcal infection had a negative urogenital test at the same visit. Conclusions Publicly funded clinics providing STD services are likely an important source of STD care for transgender persons. More data are needed to understand the most effective screening approaches for urogenital, rectal, and pharyngeal Chlamydia trachomatis and Neisseria gonorrhoeae infections in transgender populations.

Prevalence of Sexually Transmitted Infections and Human Immunodeficiency Virus in Transgender Persons: A Systematic Review

“…San Francisco, CA, was a primary study site in seven of the nine U.S. studies, with New York City, NY, and Boston, MA, also being represented in four and two studies, respectively. 11,30,31,37,38,41,45,49,50 Only one multisite study presented data from the Southeastern United States, with a study site in Atlanta, GA. 31 The non-U.S. studies included a variety of global regions, and while the majority revolved around urban areas, only one study from Argentina intentionally performed analyses on both urban and rural populations. 47 All 25 studies reported data on transgender women, with only 9 (36%) reporting data on transgender men.…”

Epidemiology of gonorrhoea: a global perspective

“…Among 105 transgender men attending STI clinics, urogenital positivity was 7.1%, pharyngeal positivity was 5.9% and rectal positivity was 14.7%. 74 Comparable positivity was found among other samples from San Francisco, California, USA and Melbourne, Australia. 73,78 In contrast, none of the 82 transgender male youth attending a community health clinic in Boston, Massachusetts, USA, had gonorrhoea.…”

“…Whereas the gonorrhoea positivity of urogenital specimens ranged from 0.1% (among 764 women from drop-in centres in Thailand) to 2.8% (among 406 STI clinic attendees at multiple sites in the USA), positivity of pharyngeal specimens ranged from 3.5 to 37.3% across studies (with positivity of 8.1-9.8% in the two largest studies from Thailand and the USA). [72][73][74][75] Positivity among rectal specimens ranged from 6.3 to 43% (9.6-11.8% in the Thailand and USA studies). [72][73][74][75][76] Two studies that did not mention the anatomic site of specimen collection found a prevalence among transgender women of 2.1% (among 63 young adults in the USA) and 4% (among 77 STI clinic attendees in Australia).…”

“…[72][73][74][75] Positivity among rectal specimens ranged from 6.3 to 43% (9.6-11.8% in the Thailand and USA studies). [72][73][74][75][76] Two studies that did not mention the anatomic site of specimen collection found a prevalence among transgender women of 2.1% (among 63 young adults in the USA) and 4% (among 77 STI clinic attendees in Australia). 77,78 Although data on transgender men are even more scarce, available data hint at high gonorrhoea prevalence.…”

Addressing Needs of Transgender Patients: The Role of Family Physicians

“…56,57 This is especially important for people of transgender experience given their elevated HIV risk. 58 Counseling about risk reduction includes discussions about HIV pre-exposure prophylaxis (PrEP) and postexposure prophylaxis. Studies indicate that knowledge about PrEP is low among transgender women.…”