Paris Keely S, Khosropour Christine M, Balkus Jennifer E, Waters Mary Bridget, Kreisel Kristen M, Manhart Lisa E
From the Department of Epidemiology, School of Public Health, University of Washington, Seattle, WA, at the time this work was completed. Currently at Washington State Department of Health, Shoreline, WA.
Department of Epidemiology, School of Public Health, University of Washington, Seattle, WA.
Sex Transm Dis. 2025 Jun 1;52(6):325-332. doi: 10.1097/OLQ.0000000000002134. Epub 2024 Dec 24.
Women who report sex with women are thought to have a lower risk of Chlamydia trachomatis (CT) infection than women who report sex with men only (WSM-only), but comparisons of lifetime burden are limited.
Among 1418 sexually experienced women aged 18 to 39 years participating in the National Health and Nutrition Examination Survey (2013-2016), we estimated weighted CT seroprevalence and Wald-based 95% confidence intervals (CIs) in women who reported ever having sex with a woman (all reported having sex with men also) (WSWM) compared with WSM-only. We defined seropositivity as detection of Pgp3 antibodies and used stratified Poisson regression with robust standard errors to estimate prevalence ratios (PRs).
More than half (58.3%) were White non-Hispanic; 16.2% were WSWM. Women who had sex with women and men were somewhat younger (mean, 27.8 vs. 29.0 years; P = 0.07), were younger at sexual debut (mean, 15.6 vs. 17.5 years; P < 0.001), and had more lifetime male sexual partners (mean, 15.9 vs. 6.4; P < 0.001) than WSM-only. Weighted CT seroprevalence was 38.9% (95% CI, 30.4%-47.4%) in WSWM and 28.6% (95% CI, 24.4%-32.9%) in WSM-only. Correlates of higher CT seroprevalence in both groups were Black non-Hispanic race/ethnicity, Hispanic ethnicity, and CT infection in the prior year. Having ≥5 lifetime male partners compared with 1 to 2 partners was associated with higher seroprevalence among WSWM (PR, 4.5; 95% CI, 1.77-11.44) and WSM-only (PR, 2.7; 95% CI, 1.87-3.69). Among WSWM, bisexual identity was associated with lower seroprevalence. Among WSM-only, low income and younger age at sexual debut were associated with higher seroprevalence.
Lifetime CT burden was higher in WSWM than WSM-only. Number of lifetime male partners was the strongest predictor of seropositivity for WSWM.
据认为，与女性发生性行为的女性感染沙眼衣原体（CT）的风险低于仅与男性发生性行为的女性（仅与男性发生性行为的女性），但对终生感染负担的比较有限。
在参与2013 - 2016年国家健康与营养检查调查的1418名18至39岁有性经历的女性中，我们估计了报告曾与女性发生过性行为的女性（所有这些女性也报告与男性发生过性行为）（与女性发生过性行为的女性）与仅与男性发生性行为的女性相比的加权CT血清阳性率及基于Wald法的95%置信区间（CI）。我们将血清阳性定义为检测到Pgp3抗体，并使用稳健标准误的分层泊松回归来估计患病率比（PR）。
超过一半（58.3%）为非西班牙裔白人；16.2%为与女性发生过性行为的女性。与仅与男性发生性行为的女性相比，与女性和男性都发生过性行为的女性年龄稍小（平均27.8岁对29.0岁；P = 0.07），首次性行为年龄更小（平均15.6岁对17.5岁；P < 0.001），且终生男性性伴侣更多（平均15.9个对6.4个；P < 0.001）。与女性发生过性行为的女性的加权CT血清阳性率为38.9%（95%CI，30.4% - 47.4%），仅与男性发生性行为的女性为28.6%（95%CI，24.4% - 32.9%）。两组中CT血清阳性率较高的相关因素为非西班牙裔黑人种族/族裔、西班牙裔族裔以及前一年的CT感染。与有1至2个性伴侣相比，有≥5个终生男性伴侣与与女性发生过性行为的女性（PR，4.5；95%CI，1.77 - 11.44）和仅与男性发生性行为的女性（PR，2.7；95%CI，1.87 - 3.69）的血清阳性率较高相关。在与女性发生过性行为的女性中，双性恋身份与较低的血清阳性率相关。在仅与男性发生性行为的女性中，低收入和首次性行为年龄较小与较高的血清阳性率相关。
与女性发生过性行为的女性的终生CT感染负担高于仅与男性发生性行为的女性。终生男性伴侣数量是与女性发生过性行为的女性血清阳性的最强预测因素。
