Expand Care for Sexually Transmitted Infections for LGBTQ+ Patients

According to the CDC, sexually transmitted infections (STIs) are defined as a pathogen that causes infection through sexual contact.¹ In 2023, there were more than 2.4 million cases of syphilis, gonorrhea, and chlamydia diagnosed and reported in the CDC STIs surveillance program.²

Pharmacist wearing a rainbow pride flag pin | Image credit: © cunaplus | stock.adobe.com

Although patients may be asymptomatic, STIs have serious consequences if left undetected. This includes pelvic inflammatory disease, human papillomavirus, and increased risk of HIV infection.³ Risk factors associated with a higher incidence of STIs include having multiple sex partners, having anonymous sex partners, having sex while under the influence of drugs and alcohol, and men who have sex with men (MSM).⁴ Health care disparities such as race/ethnicity, age, and sexual orientation have substantial impacts in screening, diagnosis, and treatment of STIs.¹

These disparities are especially prevalent among patients in the lesbian, gay, bisexual, transgender, and queer (LGBTQ+) community. In 2023, MSM accounted for one-third (32.7%) of all cases of primary and secondary syphilis, and 57.5% of cases among men with known sex of sex partners.⁴ Moreover, transgender women are consistently estimated to have as high or higher prevalence of HIV (4.5%-43% in community samples) compared with MSM (3%-15% in community samples).⁵

Furthermore, cultural assumptions about the non-sexuality of older adults, along with LGBTQ+ stigma in health care, drive reproductive and sexual health disparities among older LGBTQ+ populations.⁶ The LGBTQ+ population faces both financial and economic barriers, a lack of relevant sexual health education and knowledge, and stigma that prevents the ability of proper screening for STIs.⁷

As a result, providing access to sexual health screenings for LGBTQ+ patients has become increasingly important to prevent and treat STIs. According to the CDC, sexually active MSM need to get screened for chlamydia and gonorrhea at least annually at sites of contact (urethra, rectum) regardless of condom use, and every 3 to 6 months if at increased risk (MSM on preexposure prophylaxis, with HIV infection, or if their sex partners have multiple partners).¹ In addition, for transgender and gender diverse patients, screening recommendations should be adapted based on anatomy, which means annual, routine screening for chlamydia and gonorrhea should be expanded to all transgender men and gender diverse people with a cervix.¹ If the patient is over 25, individuals with a cervix should be screened for chlamydia and gonorrhea if at increased risk.¹

Patients who identify as MSM are at higher risk of HIV infection, with an estimated lifetime risk for HIV infection of 1 in 6, compared with heterosexual men at 1 in 524 and heterosexual women at 1 in 253. Clinicians should ask MSM patients about symptoms that are consistent with STIs, including urethral discharge, dysuria, ulcers/rash, and lymphadenopathy.¹

According to a 2010 randomized controlled trial that involved HIV-seronegative men or transgender women who have sex with men, preexposure chemoprophylaxis with emtricitabine and tenofovir disoproxil fumarate (Truvada; Gilead) was effective against the acquisition of HIV infection.⁸ In the DoxyPEP 2023 randomized controlled trial, post-exposure prophylaxis with doxycycline lowered the combined incidence of gonorrhea, chlamydia, and syphilis among MSM.⁹ Treatment options for STIs in the LGBTQ+ patient population are constantly evolving, especially in the MSM and transgender populations.

Pharmacists play a vital role in educating LGBTQ+ patients about STIs. Their accessibility and expertise in medication management make them ideal health care providers to discuss prevention strategies, medication adherence, and potential adverse effects. By fostering open and inclusive communication, pharmacists can empower LGBTQ+ individuals to make informed decisions about their sexual health, reduce the transmission of STIs, and improve overall health outcomes within this community.

REFERENCES

1. Workowski KA, Bachmann LH, Chan PA, et al. Sexually transmitted infections treatment guidelines, 2021. MMWR Recomm Rep. 2021;70(4):1-187. doi:10.15585/mmwr.rr7004a1

2. Sexually Transmitted Infections Surveillance, 2023. CDC. November 12, 2024. Accessed January 7, 2025. https://www.cdc.gov/sti-statistics/annual/index.html

3. The Dangers of Undiagnosed Sexually Transmitted Infections. American Society for Microbiology. December 8, 2022. Accessed January 7, 2025. https://asm.org/Articles/2022/December/The-Dangers-of-Undiagnosed-Sexually-Transmitted-In

4. Hufstetler K, Llata E, Miele K, Quilter LAS. Clinical updates in sexually transmitted infections, 2024. 2024;33(6):827-837. doi:10.1089/jwh.2024.0367

5. Shover CL, DeVost MA, Beymer MR, Gorbach PM, Flynn RP, Bolan RK. Using sexual orientation and gender identity to monitor disparities in HIV, sexually transmitted infections, and viral hepatitis. Am J Public Health. 2018;108(S4):S277-S283. doi:10.2105/AJPH.2018.304751

6. Siconolfi DE, Kapadia F, Halkitis PN, et al. Sexual health screening among racially/ethnically diverse young gay, bisexual, and other men who have sex with men. J Adolesc Health. 2013;52(5):620-626. doi:10.1016/j.jadohealth.2012.10.002

7. Lampe NM, Barbee H, Tran NM, Bastow S, McKay T. Health disparities among lesbian, gay, bisexual, transgender, and queer older adults: a structural competency approach. Int J Aging Hum Dev. 2024;98(1):39-55. doi:10.1177/00914150231171838

8. Grant RM, Lama JR, Anderson PL, et al. Preexposure chemoprophylaxis for HIV prevention in men who have sex with men. N Engl J Med. 2010;363(27):2587-2599. doi:10.1056/NEJMoa1011205

9. Luetkemeyer AF, Donnell D, Dombrowski JC, et al. Postexposure doxycycline to prevent bacterial sexually transmitted infections. N Engl J Med. 2023;388(14):1296-1306. doi:10.1056/NEJMoa2211934