Genital Injury at a Chicago Department of Public Health Sexually Transmitted Infection Clinic

BACKGROUND: Sub-Saharan African studies link genital coital injury (GCI) to increased HIV risk. U.S. trends of GCI are poorly described.  We measured the prevalence of GCI and associated factors in patients attending an STI clinic in Chicago.

METHODS: This cross-sectional study used a standardized survey, and abstracted exam and lab data. The frequency of 5 types self-reported GCIs in the past 6 months were measured, dichotomized as ever vs. never for analysis: scratches, cuts or abrasions (scratches) to the penile or vaginal skin; genital soreness; bleeding of the genital skin; rectal bleeding; rectal soreness. Multivariable Poisson models with robust variance identified independent factors associated with GCI. Results are presented for scratches; models were similar for other outcomes.

RESULTS: By June 2015, 335 subjects were enrolled:122 women, 146 men who have sex with women (MSW), 67 men who have sex with men (MSM).  Over the past 6 months, 34% of women, 25% of MSW, and 22% of MSM reported ever having GCI scratches. Sex ever being “rougher than you would have liked” in the past 6 months was reported by 50% of women, 34% of MSW, and 45% of MSM. Factors associated with GCI-scratch at p<0.05 for women were: rough sex [aIRR=1.63] and sex during menses aIRR=1.30]. Similar factors for MSM and MSW were being uncircumcised [aIRR=1.64] and rough sex [aIRR=2.80].

CONCLUSION: The prevalence of self-reported GCI in this urban, U.S. STI clinic is similar to that of men and women in sub-Saharan Africa, suggesting a physiological rather than cultural mechanism.