Self-Reported Bacterial Sexually Transmitted Infection Testing and Diagnoses Among a Nationwide Online Sample of United States Transgender Women, 2022-2023.

BACKGROUND

Estimates of sexually transmitted infection (STI) testing and diagnoses among US transgender women are limited, despite being important to prevention and treatment efforts.

METHODS

To evaluate self-reported bacterial STI testing and diagnoses in the past 12 months among sexually active transgender women, we surveyed a nationwide online sample of transgender women 15 years or older in 2022 to 2023. We calculated unadjusted prevalence ratios (PRs) and 95% confidence intervals (95% CIs) using log-binomial regression.

RESULTS

Among 3057 transgender women, 1012 (33.1%) reported bacterial STI testing, and of these, 159 (15.7%) reported ≥1 bacterial STI diagnosis. Testing was positively associated with condomless anal sex (PR, 1.49; 95% CI, 1.35-1.65), gender identity disclosure to a health care provider (PR, 2.25; 95% CI, 1.80-2.81), and current gender-affirming hormone therapy (PR, 1.61; 95% CI, 1.41-1.82) but negatively associated with younger age (PR, 0.72; 95% CI, 0.61-0.85) and severe depression (PR, 0.74; 95% CI, 0.57-0.96). Diagnosis of STI was greater among Black, non-Hispanic (PR, 2.28; 95% CI, 1.58-3.29) and Hispanic transgender women (PR, 1.55; 95% CI, 1.01-2.38) compared with White, non-Hispanic. Condomless anal sex (PR, 1.52; 95% CI, 1.13-2.04), problem drinking (PR, 1.20; 95% CI, 1.20-2.27), and HIV (PR, 4.51; 95% CI, 3.34-6.09) were positively associated with STI diagnosis. Current gender-affirming hormone therapy (PR, 0.51; 95% CI, 0.39-0.69) was negatively associated with STI diagnosis.

CONCLUSIONS

Bacterial STI testing was low, but diagnoses were high in this sample of transgender women. Differences in testing and diagnoses were associated with sociodemographic and behavioral factors. Sexually transmitted infection interventions tailored to transgender women are needed to increase testing and detection, prevent transmission, and reduce racial/ethnic disparities.