Prevalence of sexually transmitted infections and bacterial vaginosis among lesbian women: systematic review and recommendations to improve care

Our aim was to systematically review data about the risk of sexually transmitted infections (STI) and bacterial vaginosis among lesbian women and to suggest strategies to improve prevention, diagnosis and treatment. A search strategy for lesbian, STI and bacterial vaginosis was applied to PubMed, LILACS and BDENF databases. Of 387 unique references retrieved, 22 fulfilled the inclusion criteria (cross-sectional studies reporting prevalence for 8 STIs/bacterial vaginosis and history of a STI). The most frequent infection reported was bacterial vaginosis, and none study reported data on hepatitis B. A wide range of prevalence was observed for most infections. In terms of risk factors, the number of sexual partners, the past or current smoking, a history of forced sex and sexual stigma seem to increase the risk of STI and bacterial vaginosis. The findings of this review are discussed considering guidelines directly addressing the LGBT community’s health and relevant studies investigating both safe sexual practices and the intricate relationship between LGBT people and their care providers. A set of recommendations to improve preventive care for lesbian women is proposed. Affirming that little is known about the extent of STIs and bacterial vaginosis transmission in female-to-female sexual activities or about the risk factors for STI and bacterial vaginosis among lesbian women is reasonable. In fact, the overall quality of the studies was low or very low with significant uncertainty around their findings. However, we consider that the available knowledge indicates some paths to be followed by care providers and policy decision-makers to improve their actions towards better sexual health of lesbian women.

本研究旨在对女同性恋群体中性传播感染（sexually transmitted infections, STI）与细菌性阴道病（bacterial vaginosis）的发病风险相关数据开展系统综述，并提出优化其预防、诊断与治疗的策略。本研究针对女同性恋、性传播感染与细菌性阴道病主题，对PubMed、LILACS及BDENF数据库进行了检索。从检索获得的387篇独立参考文献中，最终筛选出符合纳入标准的22项研究，均为报告了8种性传播感染/细菌性阴道病患病率及性传播感染病史的横断面研究。本次综述纳入的研究中，报告频次最高的感染为细菌性阴道病，且无任何研究提及乙型肝炎相关数据。多数性传播感染的患病率跨度较大。就危险因素而言，性伴侣数量、既往或当前吸烟史、强制性行为史以及性耻辱感，似乎均会提升女同性恋群体感染性传播感染与细菌性阴道病的风险。本综述结合直接面向LGBT群体健康的相关指南，以及同时探讨安全性行为实践与LGBT群体及其医疗服务提供者间复杂关联的现有研究，对本次综述的结果展开了讨论。本研究提出了一系列旨在优化女同性恋群体预防性医疗服务的建议。可以合理认定，目前学界对女女性行为中性传播感染与细菌性阴道病的传播范围，以及女同性恋群体感染性传播感染与细菌性阴道病的危险因素仍知之甚少。事实上，纳入本次综述的研究整体质量偏低甚至极低，其研究结果存在显著的不确定性。尽管如此，现有研究成果仍为医疗服务提供者与政策制定者指明了优化相关工作、以改善女同性恋群体性健康的可行方向。