Research: Military women may have higher risk for STIs

(Press-News.org) As the number of women in the military increases, so does the need for improved gynecologic care. Military women may be more likely to engage in high-risk sexual practices, be less likely to consistently use barrier contraception, and, therefore, more likely to contract sexually transmitted infections (STIs), according to research recently released by a physician at Women & Infants Hospital of Rhode Island.

Vinita Goyal, MD, MPH, followed up earlier research into the rates of contraception use and unintended pregnancy by today's military women and veterans with her latest findings. Entitled "High-Risk Behavior and Sexually Transmitted Infections among U.S. Active Duty Servicewomen and Veterans," the study was published in the Journal of Women's Health.

"Studies indicate a high prevalence of risky sexual behaviors - including inconsistent condom use, multiple sexual partners, and binge drinking – that lead to unintended and unsafe sex," Dr. Goyal explains. "These high-risk sexual practices likely contribute to chlamydia infection rates that are higher than the rates in the general U.S. population. Human papillomavirus (HPV) infection and cervical dysplasia may also be higher among young, active duty servicewomen."

Dr. Goyal and her colleagues combed existing studies to uncover a snapshot of the sexual practices of active duty servicewomen. They found that:

The rates of STIs are seven times higher for military women than civilian women. Only 33% of sexually active unmarried active duty military women reported using condoms during last intercourse. Nearly 60% reported having more than one sexual partner within the last year. A separate study revealed that 27% of servicewomen surveyed reported more than one partner in the previous 90 days. In that group, only 17% reported that her partner always wore a condom. In a survey of Army recruits, 33% of female respondents reported binge drinking in the previous month, as compared with 6 to 7% of women in the general U.S. population. Binge drinking is associated with unsafe sexual practices and unwanted sexual activity among female military personnel. Thirty-one percent of female Marine Corps recruits reported having sex under the influence of alcohol or drugs in the previous three months.

In her earlier work – entitled "Unintended pregnancy and contraception among active-duty servicewomen and veterans" which appeared in the American Journal of Obstetrics & Gynecology – available evidence suggested that active-duty servicewomen were at higher risk for unintended pregnancy than civilian women. In addition, she said military rules that preclude sexual activity while deployed may serve as a barrier to women obtaining and using birth control.

"(Navy) women reported feeling stigmatized as promiscuous if they requested condoms and believed their male counterparts to be exempt from the same criticism," Dr. Goyal notes. "They also reported not using condoms because if found, it would be evidence that they were violating the military policy that prohibits sexual activity when deployed."

Whatever the reason, the limited use of condoms coupled with high-risk sexual encounters may result in STI rates that are higher than the general population. Even the rates among young recruits are higher than civilians. One study showed that 14% of military women tested positive for chlamydia, gonorrhea, and trichomoniasis upon entry to the military, compared to 8% in the non-military population. In addition, the prevalence of cervical dysplasia, precancerous changes in the cervix, and HPV is higher among servicewomen as compared to women in the general population.

Admitting that detection of chlamydia may be higher among servicewomen because military policy dictates that all female recruits be tested, Dr. Goyal said the study indicates that more research in this area is needed.

"Research investigating the true risk factors for STIs and cervical dysplasia among military women is needed," she says, adding that health care change in the military might be needed as well. "The cost associated with evaluation and treatment of abnormal Pap tests may be averted with greater implementation of the HPV vaccine in eligible military women."

As with her earlier research, Dr. Goyal used her findings to underscore the need for military health care providers to be more attuned to the reproductive health care of the growing body of females in the service.

"Understanding and addressing the needs of these women will give health care providers an opportunity to improve reproductive health care and perhaps lower the rates of sexually transmitted infections among servicewomen and female veterans," she said.

### About Women & Infants Hospital Women & Infants Hospital of Rhode Island, a Care New England hospital, is one of the nation's leading specialty hospitals for women and newborns. The primary teaching affiliate of The Warren Alpert Medical School of Brown University for obstetrics, gynecology and newborn pediatrics, as well as a number of specialized programs in women's medicine, Women & Infants is the eighth largest stand-alone obstetrical service in the country with nearly 8,400 deliveries per year. In 2009, Women & Infants opened the country's largest, single-family room neonatal intensive care unit.

New England's premier hospital for women and newborns, Women & Infants and Brown offer fellowship programs in gynecologic oncology, maternal-fetal medicine, urogynecology and reconstructive pelvic surgery, neonatal-perinatal medicine, pediatric and perinatal pathology, gynecologic pathology and cytopathology, and reproductive endocrinology and infertility. It is home to the nation's only mother-baby perinatal psychiatric partial hospital, as well as the nation's only fellowship program in obstetric medicine.

Women & Infants has been designated as a Breast Center of Excellence from the American College of Radiography; a Center for In Vitro Maturation Excellence by SAGE In Vitro Fertilization; a Center of Biomedical Research Excellence by the National Institutes of Health; and a Neonatal Resource Services Center of Excellence. It is one of the largest and most prestigious research facilities in high risk and normal obstetrics, gynecology and newborn pediatrics in the nation, and is a member of the National Cancer Institute's Gynecologic Oncology Group and the National Institutes of Health's Pelvic Floor Disorders Network.