Combating sexually transmitted infections in U.S. active-duty servicewomen: A social-ecological view of sociodemographic risk factors.

BACKGROUND

Sexually transmitted infections (STIs) are a significant health issue among U.S. military personnel. Active-duty servicewomen (ADSW) make up <20% of the U.S. military yet account for more than 33% of all military STI diagnoses. STI prevention is critical to military health and readiness.

OBJECTIVES

This review sought to (1) examine STI prevalence and risk factors among ADSW, (2) identify disparities by age, race, and rank, and (3) evaluate barriers to STI prevention and care. It also summarized evidence-based interventions to guide military public health strategies.

DESIGN

This systematic review of peer-reviewed articles and military health reports examined how demographic factors affect STI rates.

DATA SOURCES AND

METHODS

Four databases were searched with a medical librarian's guidance using STI- and military-related terms. Two reviewers independently screened 1833 records, selecting 17 studies (1996-2025) that met inclusion criteria. Data were narratively synthesized. Risk of bias was assessed using Covidence's standard domains.

RESULTS

Of the 1833 articles and reports screened from databases including PubMed and ProQuest, 17 were included. Preliminary analysis showed that ADSW have higher STI rates than servicemen. STI rates were highest among those who were young, junior enlisted, Black, and reported binge drinking. ADSW <25 years have the highest STI rates, with those aged 17-24 accounting for over 60% of chlamydia cases. Racial disparities exist within STI incidence rates; Black ADSW <25 years old experience the highest chlamydia rates (10,500 per 100,000), twice as high as White ADSW. Confidentiality concerns, stigma and limited access to healthcare services hinder care. Proposed interventions include enhancing military-specific sexual health education, expanding access to sexual health care, and implementing risk reduction programs.

CONCLUSION

High STI rates among young ADSW highlight the need for targeted interventions. Prioritizing ADSW's health helps achieve the nation's public health goals, strengthening population health and force sustainability.