Sexually Transmitted Infections (STI) Hit List
What can a lesbian catch (besides a beautiful woman)?
Current data on STI transmission between women is patchy at best. What we do know is that there have been reported cases of transmission between women of certain STIs - genital warts, pubic lice, hepatitis A and B, scabies, trichomoniasis and genital herpes. We also know that the transmission of most other STIs is theoretically possible. We are not really sure of the risk level, however it is generally agreed that the risk in most sexual activities between women is lower than during heterosexual intercourse. However, low risk does not equal no risk.
The most common STI symptom is no symptoms at all, so it is important to have a regular STI check. Most STIs can be cleared up easily if treated quickly. There have only been a few studies that provide information about sexually transmitted infections and blood borne viruses in lesbians and other women who have sex with women.
Up close with sexually transmitted infections
There have only been a few studies that provide information about sexually transmitted infections and blood borne viruses in lesbians and other women who have sex with women.
All sexually active women (including women who have sex with women) are at risk of contracting an STI. And if you or your partner has any sort of sexually transmitted infection, or blood borne virus, the potential is there to pass it on.
So testing and specific advice about reducing the risk of passing infections on are all part of prevention.
The trouble is, some infections don’t have any symptoms
Some sexually transmitted infections, like chlamydia, and even viruses like HIV, can have very few symptoms at first, or any at all, before complications occur.
The only way to find out about some infections early is to get a check-up, so you can get appropriate treatment and reduce the risk of serious complications and of passing the infection on to your sexual partners.
What happens at a sexual health check-up?
First of all, you will be asked about symptoms, and then for some details about your sexual history and sexual practices. How much you are asked depends on the clinician. How much you disclose depends on you. Whilst the questions will probably seem intrusive, they can help guide testing and the interpretation of your results. It might be easier to disclose your sexuality or sexual practices early on rather than when the questions get tricky. It is even better if you already have a doctor who knows about your sexuality, and who you can talk to easily.
If you have symptoms:
If you have any symptoms, such as a vaginal discharge, or if you are due for a Pap smear (remembering that lesbians and women who have sex with women need Pap smears too), you will be offered an examination. This will include looking at your genital area for signs of infection or skin irritation, and taking vaginal or cervical swabs for testing. And a Pap smear if it’s due. If you agree to testing for blood borne viruses (see below), you will need a small blood test.
If you have no symptoms:
It is still worth getting a check-up from time to time, as some early infections can be “asymptomatic” – this doesn’t mean they won’t go on to cause problems later! You might still be offered an examination. Or you can provide a urine sample or collect a vaginal swab in the privacy of the toilet. This can test for chlamydia, which is easily treated.
Gonorrhoea and trichomonas are not routinely tested for, unless you live in some parts of Australia where they occur more commonly. They too might not cause obvious symptoms. Testing for gonorrhoea is similar to chlamydia. Trichomonas can also be detected on certain sorts of vaginal swabs.
And even if you have no symptoms, you can still request blood tests as well.
Things that a check-up can miss:
It’s not possible to routinely test for genital warts. They are diagnosed only when you get them – small lumpy or grainy warts that are visible anywhere on the genitals.
And genital herpes is usually diagnosed clinically when symptoms occur. A swab of the affected area can confirm the diagnosis. Blood tests are available to check for evidence of past HSV infection, but as there are some problems with their reliability and interpretation, they are not routinely offered as part of a sexual health check-up.
A word about blood tests and “window periods”
A blood test cannot always detect infection as soon as a person has been exposed to the infection. It can take a while for the body to develop an antibody or immune response to an infection, which is then detected on blood testing. This delay is known as the “window period”, which can be up to 3 months for HIV, 6 months for Hepatitis B, and as much as a year (although often less) for Hepatitis C. Your doctor or nurse will ask about recent sexual contact to advise you if the window period applies to your tests.
Blood, body fluids, skin-to-skin contact & sexually transmitted infections
Rates of chlamydia are increasing, especially in young heterosexually active women and men, and in men who have sex with men. We don’t know much about rates of chlamydia in lesbians, and there are no specific guidelines about testing. Generally, women up to about 25 years old and who are sexually active are most at risk, and it is good to play it safe and include lesbians and women who have sex with women in this. It is worth having a test once a year or so to check you don’t have chlamydia, especially if you have changed partners since your previous test. You could also ask to have a chlamydia check with your next Pap smear. Chlamydia usually has no symptoms early on, but if left untreated, chlamydia can cause pelvic infection, with long-term complications including chronic pain and infertility.
> > More information on Chlamydia is available on SHFPACT’s website.
Gonorrhoea is fairly rare in some parts of Australia, common in others, and can also go unnoticed in women until it causes serious complications. These can include pelvic infection, and difficulties in pregnancy.
> > More information on Gonorrhoea is available on SHFPACT’s website.
“Trich” is a little bug that is easily transmitted through body fluids or close contact. Like gonorrhoea, it is fairly rare in some parts of Australia. It causes a vaginal discharge and sometimes a change in odour.
> > More information on Trichomonas is available on SHFPACT’s website.
There are lots subtypes of the Human Papilloma Virus (HPV). Some of these can cause genital warts. These viruses are passed on by close skin-to-skin contact. An early diagnosis of lumpy genital warts means early treatment to help clear them up.
Other HPV subtypes can contribute to the development of cervical cancer. There is good evidence that women who have sex with women get these HPV subtypes too, and that all women need Pap smears to detect changes on the cervix that HPV can cause. Early detection and treatment means much less risk of getting cancer of the cervix.
> > More information on Genital warts is available on SHFPACT’s website.
Genital herpes is very common and is easily passed on between female partners from oral sex and genital skin-to-skin contact. A first infection can be very painful and the earlier treatment is started, the quicker the symptoms improve.
> > More information on Genital herpes is available on SHFPACT’s website.
Warts and Herpes: the trouble with asymptomatic viral shedding : The really tricky thing about HPV (wart viruses) and HSV (herpes viruses) is that someone can have them without knowing. And so a woman can be infectious, or “shed” the virus, without knowing. Yes, for some women, infection with HPV or HSV can be so minor that it isn’t noticed. Yet they can still pass the infection on to their partners. This usually causes a lot of upset, especially if the newly infected partner has a lot of symptoms. So it’s worth knowing that things can get passed on even if everyone is trying to do the right thing, and getting early medical help if you think something is wrong.
Candida and Bacterial Vaginosis
Candida (“thrush” or “yeast” infection), and bacterial vaginosis (BV) are not classed as sexually transmitted infections, but they do cause genital symptoms. With BV, there is often an increase in vaginal discharge and a change in odour (which can smell unpleasant or “fishy”), sometimes with irritation of the genital skin as well. It seems to be more common in lesbians and women who have sex with women, but it’s not certain why. Medication can help settle symptoms, although recurrence is common.
This is spread through faeces (poo), so anal sex, or kissing and licking around the anus (rimming), could pass this on.
> > More information on Hepatitis A is available on SHFPACT’s website.
If Hepatitis B is around, it is fairly easy to catch both from body fluid and blood exposure. Hepatitis B immunisation is available to prevent infection. It is routine now for children and is easy for young adults to have a course of 3 immunisations, which provide very good protection.
> > More information on Hepatitis B is available on SHFPACT’s website.
Hepatitis C is harder to transmit sexually, although contact with the menstrual blood of a partner with Hepatitis C would increase the risk. The main risk for Hepatitis C is shared injecting equipment.
> > More information on Hepatitis C is available on SHFPACT’s website.
HIV is transmitted in body fluids and blood. Although a relatively rare infection in Australia, the number of women with HIV is slowly increasing (mostly women whose risk seems to have been heterosexual intercourse, with a man they did not necessarily know was infected). The risk of transmission between women seems to be relatively low, but it is possible. Blood to broken skin contact increases the risk of transmission between women, so be careful during menstruation and with sexual practices more likely to cause small grazes or bleeding. Cuts or abrasions on your hands or mouth also increase the risk. There have been case reports of transmission believed to be due to shared sex toys, so using condoms for sex toys, or not sharing toys is recommended.
> > More information on HIV is available at:
- AIDS Action Council (ACT)
- ACON (NSW)
- Queensland Association for Health Communities (QLD)
- Victorian AIDS Council (VIC)
Syphilis is common in northern parts of Australia. It can be transmitted by skin to skin contact and oral sex. The small sore that comes with initial infection isn’t painful and can be easily missed. Syphilis is easily treated if it shows up on a blood test.
> > More information on Syphilis is available on SHFPACT’s website.
Where can I have a sexual health check-up?
Having a check-up from time to time is a good idea. This can be done with your GP, at a Family Planning Clinic, (shfpact.org.au) by a women’s health nurse or at your local sexual health centre. Not everything can be checked for though, and it’s worth trying to understand the basics of what can be tested for, and what can’t.
I find it really hard to find a doctor or nurse that I’m comfortable with!
You might like to have a look at “Opening the Window - A Guide to Lesbian Health”. It’s a great booklet put together by ACON (AIDS Council of NSW). It’s full of hints to guide lesbians through the health care maze, with information on looking for the right health care providers and a range of health issues including:
- pap tests and breast check ups;
- sexual health, HIV, safe sex;
- relationships and parenting;
- alcohol, smoking and other drugs; and
- gambling and violence.
> > Go to acon.org.au and search for lesbian health to download the booklet or phone ACON for a copy.
It’s not uncommon for lesbians and women who have sex with women to also have sex with men. Don’t forget that emergency contraception can be taken to reduce the risk of unplanned pregnancy. Available from chemists, without a prescription it should be taken as soon as possible and ideally at the latest within 72 hours.
> > More information on Emergency Contraception is available on SHFPACT’s website.