Infectious Inequality

Why Women are at Higher Risk for STI Complications

When it comes to sexually transmitted infections (STIs), women are at a disadvantage. Not only are women more anatomically predisposed to acquiring STIs, but they also suffer more significant possible consequences when they do not receive timely treatment. Let’s take a deeper look at the many ways the “hidden epidemic” of STIs targets women more than men.

  • Anatomy and symptoms. Much akin to why women more frequently suffer with urinary tract infections, the female anatomy is more predisposed to infection compared to males. The vaginal lining is thin, making it easier for bacteria and viruses to take root, and unfortunately it provides a good environment for organism growth. Women are also more likely to miss STI symptoms or dismiss them as something else. A penile genital ulcer (like from herpes or syphilis), for example, is generally quite visible, while an intravaginal ulcer from the same disease may go unnoticed. Furthermore, some STI symptoms – discharge, burning, and itching, for example – are vague and may be dismissed as part of the normal menstrual cycle or misdiagnosed as another vaginal pathology like bacterial vaginosis or a yeast infection. 
  • Asymptomatic STI happens more frequently in women. Consider chlamydia and gonorrhea, the top two most common treatable STIs. Up to 75% and 50% of women, respectively, have no symptoms of the disease. When we talk about men, those asymptomatic numbers cut to 40% for chlamydia and 10% for gonorrhea.
  • STIs can have serious health complications in women. For men, there are two major consequences of unrecognized or untreated STI: it can be unknowingly spread to sexual partners, and eventually it will cause symptoms and discomfort. But once that man seeks and receives treatment (assuming it is a treatable STI like chlamydia or gonorrhea), the infection most often goes away and no long-term damage is done. For women – you guessed it – untreated STIs can have many ramifications, especially when there are no symptoms and the woman has no reason to seek care:
    • Chronic pelvic pain
    • Pelvic inflammatory disease (PID) – infection of upper reproductive organs that occurs in 10-15% of untreated chlamydia.
    • Infertility – results from PID that can cause permanent damage to the reproductive tract.
    • Tubal or ectopic pregnancy – another result of reproductive damage from PID.
    • Spreading the STI to their baby – genital herpes, syphilis, and HIV can all be passed to babies during delivery. Stillbirth, low birth weight, brain damage, blindness, and deafness are possible consequences.
    • Genital warts and cervical cancer – HPV is the most common STI and is the main cause of cervical cancer. HPV is also common in men, but most do not develop any serious health complications.

All to say, the odds are stacked much higher against women than men when it comes to STI. However, we now have access to a tool that can help improve STI outcomes for women: the STI Screen. Many health organizations, including the CDC, publish screening recommendations to help identify asymptomatic disease in women. The recommendations vary slightly based on the particular STI, but for chlamydia and gonorrhea the CDC recommends screening all sexually active women under 25 years of age at least once annually. This annual screening recommendation is extended for women older than 25 if certain risk factors are present such as having a new partner, more than one partner, or a partner with a known STI.

At Industry Lab, we combine our state-of-the-art PCR testing and rapid turnaround time with a commitment to improving the sexual health of the communities we serve. Our sexual health tests are specifically designed to align with the CDC recommendations so patients can receive fast and affordable screening and testing. 

Whether you practice in primary care, emergency medicine, a subspecialty clinic, an addiction center, or a pediatric office, we all can do our part to screen patients, identify asymptomatic STIs, and improve STI care for women. Contact ILDP today to learn how we can partner with you to deliver best-in-class STI laboratory services!

Dr. CJ Michaud

ILDP Director of Clinical Treatment