WSW - Women who have sex with women

Overview

  • Current evidence indicates that women who have sex with women (WSW) have the same rate of STIs as heterosexual women, however the prevalence of particular STIs differs between these groups. WSW should not be presumed to be at low or no risk for STIs based on sexual orientation.
  • Few data are available on the risk for STIs transmitted by sex between women, but risk probably varies by the specific STI and sexual practice (e.g. oral-genital sex; vaginal or anal sex using hands, fingers, or penetrative sex toys; and oral-anal sex).
  • WSW are at risk for acquiring bacterial, viral, and protozoal infections from current and prior partners, both male and female. Up to 90% of this group of women have had or continue to have male sexual partners
  • Prevalence of bacterial vaginosis estimates are significantly higher for WSW than exclusively heterosexual women: studies in WSW demonstrate BV prevalence of 20-50%.
  • Recent studies indicate that some WSW, particularly adolescents, young women, and women with both male and female partners, might be at increased risk for STIs and HIV as a result of certain reported risk behaviors including injecting drug use and sex work.

Testing advice

InfectionConsideration
Chlamydia Female to female transmission uncommon.  
Gonorrhoea Female to female transmission uncommon. 
Trichomoniasis Nil
Bacterial vaginosis

Nil

Hepatitis B  Vaccinate if negative.
Syphilis

Consider window period and history.

No data on female to female transmission. Female sex partners should be tested if positive.

HIV

Consider window period and history

Female to female transmission uncommon. Female sex partners should be tested if positive

NAAT – Nucleic Acid Amplification Test

Specimen collection

Urine Collection
Swab Collection 

Investigations and clinical indicators for testing

  • WSW are a diverse group with variations in sexual identity, sexual behaviours, sexual practices, and risk behaviours. Testing of WSW will depend on the history, the clinical picture and risk factors identified.
  • Routine cervical cancer screening should be offered to all WSW and WSW should be offered the human papillomavirus (HPV) vaccine in accordance with current guidelines. It is not recommended to routinely test for herpes and genital warts with serology. Consider testing for herpes and genital warts only if there are clinical signs and symptoms.

Special considerations

  • Trichomonas transmission occurs between women, therefore treat partners as well
  • Bacterial vaginosis is highly associated with WSW and is high in female-female partnerships. No partner treatment trials have been performed, therefore standard recommendations are that female partners of women with bacterial vaginosis should be offered testing and treatment.

Follow up

If screening test results are positive, refer to STI management section for advice:

Even if all test results are negative, use the opportunity to:

  • Educate about safe sex practices, drug use and risk minimisation
  • Vaccinate for hepatitis B if susceptible
  • Discuss and activate reminders for regular screening tests according to risk - especially if their behaviors indicate the need for more frequent screening
  • Discuss need for cervical screening.

Auditable outcomes

For 100% WSW, testing is discussed openly and opportunities for further engagement are made available.

References

  1. http://www.cdc.gov/std/treatment/2010/specialpops.htm#wsw
  2. Melbourne Sexual Health Clinic (2011). Screening Asymptomatic Women who have sex with women policy and procedure.
  3. Marazzo, J. (2002). STD and Genitourinary infections in lesbians: practical and research update, Washington.
  4. McNair, R. (2009). Lesbian and bisexual womens sexual health, Australian Family Physician, 38(6), 388 – 393.
Last Updated: Friday, 10 October 2014