(P183) Are sexual minority women more at risk for rectal sexually transmitted infections than their heterosexual counterparts? STD Surveillance Network, January 2020-August 2022

Background: High rectal sexually transmitted infection (STI) prevalence among sexual minority men is well documented, but less is known of women’s risk by sexual behavior. Some reports indicate women having sex with men and women may be at higher risk of rectal STI acquisition. This analysis compares rectal chlamydia (CT) and gonorrhea (GC) positivity among women based on gender of sex partners.

Methods: We evaluated rectal CT and GC positivity using cross-sectional data during 1/2020-8/2022 in 13 STD clinics participating in the STD Surveillance Network. Cisgender women who reported ≥1 male and/or female sexual partners in the previous 3 months were included. Women were divided into 3 behavioral groups: women having sex with women only (WSWO), women having sex with men only (WSMO), and women having sex with women and men (WSWM). We examined results of the first visit when tested for rectal CT and GC.

Results: A total of 30,549 women (730 WSWO, 2,116 WSWM, 27,703 WSMO) were included. HIV prevalence was comparable across groups (1.5% in WSWM; 1.0% in WSWO; 1.0% in WSMO). WSWM had a higher median number of partners (3, interquartile range [IQR]: 2–4) than WSMO (1, IQR: 1–2) or WSWO (1, IQR: 1–2). Overall, rectal testing was performed in 6.9% (n=2,107) of patients but varied by group (12% for WSWM vs. 6% for WSWO and WSMO, p< 0.05). Fifteen (38.5%) of the 39 WSWO reported rectal exposure vs. 941/1801 (52.3%) WSMO and 175/267 (65.5%) WSWM (P < 0.05). Rectal positivity for either pathogen was 13.8%. Rectal CT positivity among WSWO was 10.3% (4/39) compared to 9.2% for WSMO (164/1795), and 8.6% for WSWM (23/267) (P >0.05). GC positivity among WSWO was 0% (0/39) compared to 5.7% for WSMO (102/1797) and 5.2% for WSWM (14/267) (p >0.05).

Conclusion: Our findings indicate a substantial burden of rectal STI among women, with rectal testing varying by group. However, rectal CT positivity was similar in all 3 groups and rectal GC positivity was comparable in WSMO and WSWM. Our findings do not demonstrate increased rectal STI positivity among women who report same-sex and sex with men, despite more frequent testing and exposure.