Prevalence Rates of Sexually Transmitted Infections Among Women Who Have Sex with Women, Emphasizing African Americans: Implications for Research and Policy

Background:
The risk of transmitting and acquiring a sexually transmitted infection (STI) between two female partners has traditionally been considered to be low or absent.

Objective:
To review current literature citing prevalence rates of STIs among women who have sex with women (WSW), emphasizing African American WSW, to determine how to best serve this population.

Method:
A systematic review of the medical literature was performed through a MEDLINE search using the terms ‘sexually transmitted infection,' ‘lesbian,' ‘homosexual,' ‘human immunodeficiency virus (HIV),' ‘genital herpes,' ‘human papillomavirus,' ‘genital warts,' ‘cervical intraepithelial neoplasia,' ‘syphilis,' ‘Chlamydia,' ‘gonorrhea,' ‘trichomonas,' and ‘hepatitis B/C.' Only original articles of research between January 1, 1980 and September 1, 2007 were included.

Result:
Seventeen articles were identified with ethnicity described in fourteen. Caucasians constituted the majority of women in twelve studies, ranging from 54-94%. Rates of human papillomavirus ranged from 0-30%, genital warts 0-16%, cervical intraepithelial neoplasia 0-6%, genital herpes 0-11%, and hepatitis B 5.4-7%. Rates of HIV, gonorrhea, Chlamydia, trichomonas, syphilis, and hepatitis C were below 5%. African American WSW constituted over half (56.3%) of the population in only one article involving 135 predominately bisexual women. HIV prevalence rate was 17% and linked to injection drug use and heterosexual contact.

Conclusion:
WSW are at risk for acquiring and transmitting STIs, especially certain viral infections, and should be screened for these infections. The bulk of this data was obtained in Caucasians. STI prevalence rates in African American WSW are currently not well described. Unique medical needs regarding prevention counseling and screening for STIs in this population are unknown at this time.

Implications:
Further research is necessary to determine risk behaviors and STI prevalence rates in African American WSW so that educational programs and policies specifically addressing the needs of this population can be implemented.