Women Who Have Sex with Women (WSW): STI Risks
December 2015 MI Science Staff
A survey on sexual behavior in the United States that was collected from 2006-2008, showed that about 13% of females had some sort of same sex intimate contact at some time in their life. 1 The term “lesbian” is used to describe a woman who is sexually attracted to other women and has sexual relations with women, while the term “bi-sexual” refers to a person who is attracted to both sexes and engages in sexual relations with both sexes. Women who have sex with women or WSW, is a term that includes both lesbians and bisexual women. 2
Unfortunately, many people believe that WSW are at minimal or no risk for contracting sexually transmitted infections (STIs). This is a dangerous misconception that can delay diagnosis and lead to advanced sexually transmitted diseases (STDs), including pelvic inflammatory disease and even AIDS. Transmission of STIs can take place with skin to skin contact, oral-genital sex, digital stimulation and use of contaminated sex toys.
A significant case study from Houston, Texas in 2012, indicates that female-to-female transmission of the HIV virus is a reality.3 Before the Houston incident, other reports of transmission of HIV from WSW were complicated by other risk factors, such as blood transfusions, injectable drug use, and sexual contact with males. However, in this case study, the couple was in a monogamous relationship with no other reported risk factors and the infecting virus was genetically the same in both women.
HPV (human papillomavirus) is common in WSW, just as it is in the general population. HPV can be transmitted through skin to skin contact and has been shown to occur in women who have reported no male sexual contact. High risk forms of the virus carry the potential for cervical and other cancers; therefore, the CDC guidelines suggest that all women be encouraged to have regular pap smears and HPV vaccines, regardless of their sexual orientation.4
Since oral-genital sex is a frequent practice of women who have sex with women, genital herpes transmission with both HSV-1 and HSV-2 can occur. A National survey from 2001-2006, reported that 30% of women who reported having same-sex sexual contact in the past year, had positive blood tests for HSV-2. This finding is contrasted with women who report no same-sex sexual contact, among whom 24% had positive blood tests for HSV-2.5
Besides the threat of incurable viral STIs, WSW also risk acquiring bacterial sexually transmitted infections and protozoal infections, specifically trichomonas. All sexually active females under the age of 26 years, should be screened for chlamydia and gonorrhea yearly, as well as older women who have had more than one sexual partner in the past year.2 Transmission of Syphilis has also been known to occur in WSW, which can result from skin to skin contact or oral-genital sex.
- Chandra A, Mosher WD, Copen C, et al, “Sexual Behavior, Sexual Attraction, and Sexual Identity in the United States: Data from the 2006-2008 National Survey of Family Growth,” National Health Statistics Reports, Number 36, March 3, 2011.
- Grimes, Jill MD, editor, Sexually Transmitted Disease: An Encyclopedia of Diseases, Prevention, Treatment and Issues,( 2014) Greenwood Publishers, Santa Barbara, Ca.
- Centers for Disease Control and Prevention, “Likely Female-to-Female Sexual Transmission of HIV- Texas, 2012,” Morbidity and Mortality Weekly Report, March 14, 2014/63(10) http://www.cdc.gov/mmwr/preview/mmwrhtml/mm6310a1.htm
- Centers of Disease Control and Prevention, “Sexually Transmitted Diseases Treatment Guidelines, 2015,” MMWR Recommendations and Reports/Vol.64/No.3. http://www.cdc.gov/std/tg2015/tg-2015-print.pdf
- Xu F, Sternberg MR, Markowitz LE, et al, “Women who have sex with women in the United States: prevalence, sexual behavior and prevalence of herpes simplex virus type 2 infection-results from national health and nutrition examination survey 2001-2006,” Sexually Transmitted Disease 2010;37:407-13.