Sexually Transmitted Infections in Substance-Using Women: Implications for Prevention and Practice

Background: There are approximately 15.3 million new cases of STIs in the U.S. annually; Gonorrhea, Chlamydia and Trichomonas are the most common among women. Without symptoms or cues to seek episodic care, asymptomatic STIs are most likely to be detected during routine health examinations. However, marginalized groups of women, including current or former substance users, often lack regular care providers and may experience significant delays in seeking and obtaining care.

Methods: The purpose of the study was to examine the prevalence of STIs among substance-using women in inpatient and outpatient substance abuse treatment programs in Philadelphia, and identify disparities in STI rates by race/ethnicity.

As part of a larger longitudinal intervention study, 525 substance-using women were tested for Chlamydia, Gonorrhea, and Trichomonas at baseline and follow-ups.

Results: At baseline, more than 17% of women tested positive for one or more STIs. Rates among African American and Hispanic women were 2.5 and 4.0 times higher, respectively, than those of non-Hispanic White women. Post-intervention rates are currently being analyzed.

Conclusion: Many substance-using women engage in sexual behaviors that place them at high risk for STIs. Many lack primary care providers and access to preventive gynecological care. Substance abuse treatment programs may provide unique opportunities for early diagnosis and treatment of STIs. Public health STI prevention programs that provide STI testing and treatment at substance abuse treatment sites may capitalize on this “contact point with care” and may be able to reduce STIs and long-term sequelae among substance abusing women and their partners.