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.

本研究旨在系统回顾女同性恋女性人群中性传播感染（sexually transmitted infections, STI）与细菌性阴道病（bacterial vaginosis）的相关发病风险数据，并提出优化其预防、诊断与治疗方案的策略。我们针对女同性恋、性传播感染及细菌性阴道病构建检索策略，检索了PubMed、LILACS及BDENF数据库。在检索得到的387篇去重文献中，共有22篇符合纳入标准：均为报告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。纳入研究中报告频次最高的感染为细菌性阴道病，无研究涉及乙型肝炎相关数据。多数感染的患病率区间跨度较大。在危险因素方面，性伴侣数量、既往或当前吸烟史、强制性行为史以及性污名（sexual stigma）似乎会升高女同性恋女性罹患性传播感染与细菌性阴道病的风险。本综述结合直接针对女同性恋、男同性恋、双性恋与跨性别（LGBT）群体健康的相关指南，以及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互动关系的既有研究，对本次综述的结果展开讨论。本研究提出一系列旨在优化女同性恋女性预防保健服务的建议。可以合理推断，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规模，以及女同性恋女性群体中此类感染的危险因素仍知之甚少。事实上，纳入研究的整体质量偏低或极低，其研究结果存在显著不确定性。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、以改善女同性恋女性性健康的可行方向。