Patterns of Sexual Practices, Sexually Transmitted Infections and Other Genital Infections in Women Who Have Sex with Women Only (WSWO), Women Who Have Sex with Men Only (WSMO) and Women Who Have Sex with Men and Women (WSMW): Findings from a Sexual Health Clinic in Melbourne, Australia, 2011–2019

Abstract

Despite rises in sexually transmitted infection (STI) notifications among Australian women in the last decade, limited STI surveillance data exist specifically for women who have sex with women. This study aimed to compare differences in sexual practices and positivity for STIs and other genital infections among women who have sex with men only (WSMO), women who have sex with women only (WSWO), and women who have sex with men and women (WSMW), and whether these changed over time. In this retrospective repeated cross-sectional study, women attending the Melbourne Sexual Health Centre for the first time between 2011 and 2019 were categorized as “WSMW,” “WSWO,” or “WSMO” according to self-reported sexual practices in the previous 12 months. Demographic information, sexual practices, and positivity for STIs and other genital infections were compared between the three groups and over time. A total of 36,147 women (2618 WSMW, 534 WSWO, and 32,995 WSMO) were included. WSMW reported more sexual partners (median = 6; IQR = 4–10) than WSMO (median = 3; IQR = 2–5) and WSWO (median = 2; IQR = 1–4) (p < .001). A higher proportion of WSMW always used condoms with casual male partners compared to WSMO (20.4% vs 15.9%; p < .001). The proportion of women who always used condoms with casual male partners decreased over time in WSMO, (19.9% in 2011 to 15.2% in 2019, ptrend < .001) but not in WSMW. Bacterial vaginosis was more common in WSWO (14.8%) than in WSMW (11.8%) and WSMO (7.7%) (p < .001). Chlamydia was more common in WSMO (9.3%) than in WSMW (6.6%) and WSWO (1.2%) (p < .001). Syphilis was more common in WSMO (1.0%) than in WSMW (0.3%) and WSWO (0.0%) (p = .004). Over time, chlamydia positivity in WSWO increased (from 0.0% to 2.7%, ptrend = .014), and syphilis positivity in WSMW increased (from 0.0% to 0.7%, ptrend = .028); however, positivity of these STIs did not change in other groups. Sexual practices and positivity for STIs and other genital infections differed according to the sex of women’s partners in the previous 12 months. Knowledge of these differences is important to account for future changes in STI trends that may occur in these subpopulations.

Bacterial Vaginosis Treatment Patterns, Associated Complications, and Health Care Economic Burden of Women With Medicaid Coverage in the United States

“…Other studies have indicated BV to be more common among people of younger age and/or those who are black; 1,2 , 24-26 however, many other factors have also been associated with increased prevalence or risk of BV and its recurrence, including low socioeconomic status, alcohol and cigarette use, having multiple sexual partners, sexual orientation, obesity, vaginal care practices, and vaginal microbiome composition. 1,2 , 7-12 , 24-29 Given the age distribution of our study population was relatively consistent with that found in other Medicaid populations (2013-2017) in the published scientific literature, 30 but the proportion of black patients was higher, our data suggest that black patients with Medicaid coverage may be more affected by BV than other race/ethnicity groups. Medicaid programs cover >16 million women of reproductive age across the United States whose income is <200% of the federal poverty level with a high representation of racially and ethnically diverse women.…”

“…[5][6][7] Other factors, such as baseline vaginal microbiome composition, biofilm accumulation, antimicrobial resistance, number of sexual partners, and sexual orientation, can also influence BV recurrence and its frequency. [7][8][9][10][11][12] There is very little information in published scientific literature of optimal treatment strategies for recurrent BV, except that there are few therapeutic options and a lack of progress in any methods of prevention. 7 The widespread occurrence of incident BV, high frequency of recurrence, and current treatment and prevention limitations all signify an unmet need for improving women's reproductive health care in the United States.…”

Time to healthcare seeking following the onset of symptoms among men and women attending a sexual health clinic in Melbourne, Australia

“…MSW were defined as sexually active men who had never had sex with another man. Women were not stratified based on sexual practices due to the small number of women who have sex with women attending the MSHC ( 24 ). We calculated the straight-line distance between the individual’s residential postcode and the MSHC, to determine the distance from home to the MSHC.…”

Increased syphilis testing and detection of late latent syphilis among women after switching from risk-based to opt-out testing strategy in an urban Australian sexual health clinic: a retrospective observational study

“…1 A sharp increase in syphilis cases among heterosexual men and women, especially those of child-bearing age, Aboriginal and Torres Strait Islander peoples and women pregnant at the time of diagnosis, has caused considerable concern. 2 , 3 , 4 , 5 In particular, the increasing rate of syphilis in women of reproductive age has been identified as a public health priority due to its association with congenital syphilis, which is complicated by congenital defects, prematurity, low birth weight and stillbirth. 1 , 6 , 7 In Victoria, the proportion of syphilis cases that are women increased from 8.8% in 2016 to 12.8% in 2020.…”