Urine and Rectal STI Diagnoses among Drug-Using Transgender Women

Background: Although high rates of HIV infection among transgender women (TGW) have been reported, little is known about rates of other STIs such as syphilis, and even less regarding rectal Neisseria gonorrhoeae and Chlamydia trachomatis (GC/CT).

Methods: To date, we have recruited a sample of 60 drug using TGW at risk for HIV infection or transmission into a group-based intervention with HIV/STI testing for urethral and rectal gonorrhea and chlamydia (GC/CT) and syphilis.

Results: A majority of the sample consisted of TGW of color, primarily Black (28.6%) and Latina (48.2%); the average age was 32, and 39% were HIV-positive. The most frequently reported drug used was marijuana (78.3% of participants), followed by cocaine/crack (35.0% of participants). On average, women reported 12.8 sexual partners in the prior 60 days (Mdn=5.0) and 30.7 anal/vaginal sex acts (Mdn=20.0), of which 43.9% were condomless. Prevalence of urethral NG/CT was 3.6% whereas rectal was nearly triple that (10.7%); 6.7% had an active syphilis infection and an additional 17.8% had a previously treated infection. Overall prevalence of any active STI was 19.5%, and prevalence was highest among those using drugs other than marijuana (63%), followed by club drug users (23.8%) and marijuana-only users (15.0%). STI prevalence did not significantly differ by HIV-status.

Conclusions: Drug-using TGW present with above-average rates of active and previously treated syphilis, and rectal GC/CT was more common than urethral. Providers of services for TGW should conduct routine screening for all STIs, including rectal GC/CT, and services for substance use should be offered.