The US based Centre for disease control (CDC) has recently updated its factsheet on lesbian and bisexual health. The CDC emphasises the potential risks of acquiring sexually transmitted infections and HIV from certain sexual practices. The article provides advise on how lesbian and bisexual women can protect themselves.
Female sex workers (FSWs) are assumed to be at increased risk of sexually transmitted infections (STIs). Using routine STI surveillance data, McGrath-Lone et al in an article published in the latest issue of Sexually Transmitted Infections investigated differences in sexual health between FSWs and other female attendees at sexual health (genitourinary medicine – GUM) clinics in England.
They reported on 2704 FSWs visiting to 131/208 GUM clinics, (primarily large, FSW-specialist centres in London) in 2011. By comparison with other female attendees, FSWs travelled further for their care and had increased risk of certain STIs (eg, gonorrhoea Odds Ratio: 2.76, p<0.001). Significantly migrant FSWs had better sexual health outcomes than UK-born FSWs (eg, period prevalence of chlamydia among those tested: 8.5% vs 13.5%, p<0.001) but were more likely to experience non-STI outcomes (eg, pelvic inflammatory disease OR: 2.92, p<0.001).
They concluded that although FSWs in England have access to high-quality care through the GUM clinic network, there was evidence of geographical inequality in access to these services.
A minority do not appear to access STI/HIV testing through clinics, and some STIs are more prevalent among FSWs than other female attendees.
Targeted interventions aimed at improving uptake of testing in FSWs should be developed, and need to be culturally sensitive to the needs of this predominantly migrant population.
Bacterial vaginosis (BV) is the commonest vaginal infection seen in women. The Centre of Disease Control (CDC) has recently updated its fact sheet on this common condition.
BV is linked to an imbalance of “good” and “harmful” bacteria that are normally found in a woman’s vagina. Having a new sex partner or multiple sex partners and douching can upset the balance of bacteria in the vagina and put women at increased risk for getting BV.
BV can cause some serious health risks, including:
Increasing your chance of getting HIV if you have sex with someone who is infected with HIV;
If you are HIV positive, increasing your chance of passing HIV to your sex partner;
Making it more likely that you will deliver your baby too early if you have BV while pregnant;
Increasing your chance of getting other STDs, such as chlamydia and gonorrhoea.
These bacteria can sometimes cause pelvic inflammatory disease (PID), which can make it difficult or impossible for you to have children.
Bacterial vaginosis (BV) is a common condition in women presenting as a malodorous vaginal discharge. The smell is often worse after sex and arround the menstrual period. Occasionally there is an associated itching or burning sensation although most women with BV only have the discharge. BV can also be detected in women who are totally symptom free.
BV is caused by an imbalance of the normal vagina flora and its mechanism remain poorly understood. An updated review by the Centre for Disease Control (CDC), USA confirms a commonly observation that BV follows sexual intercourse with a new partner and multiple partners as well as vaginal douching.
BV, itself an benign though troublesome nuisance is associated with increased risk of a number of infections or conditions:
Having BV can increase a woman’s susceptibility to HIV infection if she is exposed to the HIV virus.
Having BV increases the chances that an HIV-infected woman can pass HIV to her sex partner.
Having BV has been associated with an increase in the development of an infection following surgical procedures such as a hysterectomy or an abortion.
Having BV while pregnant may put a woman at increased risk for some complications of pregnancy, such as preterm delivery.
BV can increase a woman’s susceptibility to other STDs, such as herpes simplex virus (HSV),chlamydia, and gonorrhea.
- The bacteria that cause BV can sometimes infect the uterus (womb) and fallopian tubes (tubes that carry eggs from the ovaries to the uterus). This type of infection is called pelvic inflammatory disease (PID).
- Pregnant women with BV more often have babies who are born premature or with low birth weight (low birth weight is less than 5.5 pounds). Pregnant women who have had previous premature of low birth weight babies should be tested and treated for BV in third trimester regardless of symptoms.
Trichomonas vaginalis (TV) is the most prevalent curable sexually transmitted infection (STI) globally. Yet at least 80% of TV infections are asymptomatic, though even asymptomatic infections are a public health concern.
In addition to the risk of transmission to sex partners, TV infection has been associated with as much as a 2.7-fold increase in the risk of HIV acquisition, a 1.3-fold increase in the risk of preterm labour, and a 4.7-fold increase in the risk of pelvic inflammatory disease.
A recent review in the journal Sexually Transmitted Infections (STI) highlights the current knowledge of the global epidemiology of TV infection. These include sex differences in the incidence and prevalence of infection, and the potentially important role of female sex hormones, and the menstrual cycle in mediating TV susceptibility and natural history.
WHO has estimated that over half the 248 million new TV infections each year occur in men. By contrast, 89% of prevalent TV cases are found among women. Biological differences between the sexes contribute to these striking differences between men and women.
There has also been an increased understanding of the mechanisms underlying resistance to metronidazole – the current sole drug available to eradicate the organism.
Recent innovations in detection, including the availability of nucleic acid amplification tests (NAATs), have improved our understanding of the natural history of TV infections. These innovations and our increased understanding of this common sexually transmitted infection should help us combat the global epidemic in TV.
The optimal diagnostic sample for Chlamydia trachomatis detection should detect the maximum number of infected people. In women without symptoms the sample of choice is a self taken vulvovaginal swab, which can be done in the privacy of one’s home. But it is not clear whether a vulvovaginal swab or an endocervical swab is the optimum sample in women with symptoms requiring speculum examination.
A recent study by Sarah Shoeman and colleagues published in the BMJ compared the two sampling methods. They showed that in women attending a sexual health centre vulvovaginal swabs were significantly better at detecting chlamydia infection than endocervical swabs among women with symptoms of a sexually transmitted infection.
In these cases, using endocervical samples rather than vulvovaginal swabs would have missed 9% of infections, or 1 in 11 cases of chlamydia infection
A parallel study by the same group showed that self taken vaginal swabs tested by the Nucleic acid amplification tests (NAATs) which offer increased sensitivity for detecting gonorrhoea, is significantly more sensitive and offers good specificity for detecting gonorrhoea compared with standard gonorrhoea culture methods.
However confirmation of positive results with a second NAAT is essential in low prevalence populations such as the UK, to avoid false positive results
Women and clinicians can be confident that self taken vulvovaginal swabs are as accurate as clinician performed tests for the detection of chlamydia and gonorrhoea in women without symptoms and should be the test method of choice in asymptomatic women.