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Original research
Factors associated with sexually transmitted infection diagnosis in women who have sex with women, women who have sex with men and women who have sex with both
  1. Nazia Rahman1,2,
  2. Khalil G Ghanem3,
  3. Elizabeth Gilliams3,4,
  4. Kathleen R Page3,
  5. Susan Tuddenham3
  1. 1 Henry M Jackson Foundation for the Advancement of Military Medicine, USU Preventive Medicine and Biostatistics, Bethesda, Maryland, USA
  2. 2 Infectious Disease Clinical Research Program, Uniformed Services University of the Health Sciences, Bethesda, Maryland, USA
  3. 3 Department of Medicine, Division of Infectious Diseases, Johns Hopkins University School of Medicine, Baltimore, MD, USA
  4. 4 Baltimore City Health Department, Division of Population Health and Disease Prevention, Sexual Health Clinics, Baltimore, Maryland, USA
  1. Correspondence to Dr Susan Tuddenham, Infectious Diseases, Johns Hopkins University, Baltimore, MD 21218, USA; studden1{at}


Introduction Many US women report same sex behaviour, yet data on risk factors and STIs in women who have sex with women (WSW), women who have sex with both men and women (WSB) and how these compare to women who have sex with men only (WSM) remain limited. Here we compared self-identified WSW, WSB and WSM attending two STI clinics in Baltimore, Maryland.

Methods This was a retrospective analysis using a database of first clinic visits 2005–2016. WSW and WSB were compared with an age-matched random sample of WSM. Proportions were compared using the χ2 test. Acute STI (aSTI) was defined as gonorrhoea (Neisseria gonorrhoeae, GC), chlamydia (Chlamydia trachomatis, CT), trichomonas (Trichomonas vaginalis, TV) or early syphilis. Logistic regression was used to assess aSTI predictors. CT testing was not uniformly done, so a sensitivity analysis removing CT from the aSTI definition was conducted.

Results Visits from 1095 WSW, 1678 WSB and 2773 WSM were analysed. WSB had equal or higher test positivity for all STIs except urogenital chlamydia, had more sexual partners, were more likely to engage in transactional sex and were more likely to report drug use and binge drinking than WSM (p≤0.01). WSW had lower test positivity for urogenital GC and CT than WSM or WSB, but comparable test positivity for TV, higher reported binge drinking and comparable reported substance use as WSM. Younger age and cocaine use predicted STI diagnosis only in WSM.

Conclusions WSB in these clinics bear an equal or higher burden of most STIs, have more partners and report more substance use than WSM. WSW carry a lower, but still substantial burden of STIs, and many report substance use. Factors predicting STI diagnosis differ between WSW, WSB and WSM suggesting that tailored STI prevention and testing approaches are needed in these groups.

  • Chlamydia trachomatis
  • gonorrhoea
  • health services research
  • heterosexual
  • homosexuality

Data availability statement

No data are available. N/A.

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  • Handling editor Jo Gibbs

  • Contributors KG and ST conceived the analysis. NR and ST conducted the analysis. All authors contributed substantially to guiding the analysis and revising the manuscript.

  • Funding ST is supported by NIH grant K23AI125715.

  • Competing interests ST reports she has been a consultant for Luca Biologics, BioFire Diagnostics and Roche Molecular Diagnostics and has received a speaker honorarium from Roche Molecular Diagnostics.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Author note Affiliation of Nazia Rahman at time of analysis:Johns Hopkins Bloomberg, School of Public Health, Master’s in Public Health Program, Baltimore, USA.