New sexual health campaigns needed for women: study

A large-scale study has investigated the connection between
female sexual practices and STI rates for the first time.
Image: Centre for Sexuality

by Anne Crawford

A rise in sexually transmitted infection (STI) among Australian women in the past decade has prompted Monash University researchers to investigate the connection between female sexual practices and STI rates for the first time in women who have sex with women.

The large-scale 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. It included data on 36,147 women who attended the Melbourne Sexual Health Centre (MSHC) between 2011 and 2019.

 
The study’s findings were published this month in ‘Archives of Sexual Behaviour’.

“We’d previously done a study and found increases in syphilis and gonorrhoea cases in women in Victoria but couldn’t understand why,” the MSHC’s Associate Professor Eric Chow, said. “These two STIs are relatively uncommon in women and heterosexual men but we are seeing a rapid rise in them in women in the last five years,” Associate Professor Chow said. “There is also lots of concern about congenital syphilis re-emerging, which is causing deaths of babies, which we really don’t want to see.”

Studies had been conducted showing differences in STI rates between gay and heterosexual men; Associate Professor Chow decided to stratify women to see if there were differences. Limited STI surveillance data had previously existed specifically for women who have sex with women, he said.

The study found that bisexual women reported more sexual partners than the other two groups. The proportion of women who always used condoms with casual male partners decreased over time in heterosexual women (19.9% in 2011 to 15.2% in 2019) but not in bisexual women.

Bacterial vaginosis was more common in lesbian women (14.8%) than in bisexual (11.8%) and heterosexual ones (7.7%). Chlamydia was more common in heterosexual (9.3%) than in bisexual (6.6%) and lesbian (1.2%) women. Syphilis was more common in heterosexual women (1.0%) than in bisexual ones (0.3%) and there were no reported cases in lesbian women. Over time, chlamydia positivity in lesbian women increased (0 to 2.7%), and syphilis positivity in bisexual women increased slightly from 0.0 to 0.7%; however, positivity of these STIs did not change in other groups.

Associate Professor Chow said knowing the differences between women with different practices was important to account for future changes in STI trends that may occur in these sub-populations, and for public health education.

“Most of the public health campaigns mainly target gay and bisexual men,” he said. “We need more STI public health campaigns to target other populations such as women.

“We know there may be some sexual health differences between orientations, so we probably need to tailor within that population. It is also important to increase symptoms awareness and recognition, so they can see a doctor immediately to get treatment and to prevent ongoing transmission.”

Associate Professor Chow said there was a caveat on the findings as the study was conducted in one sexual health centre so didn’t account for geographical differences in STI rates.

First author on the paper was medical student Jaimie Engel at Monash University.

Engel JL, Fairley CK, Greaves KE, Vodstrcil LA, Ong JJ, Bradshaw CS, Chen MY, Phillips TR, Chow EPF. 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 Arch Sex Behav. 2022 Jul 1. doi: 10.1007/s10508-022-02311-w. Epub ahead of print. PMID: 35776396.