Female Sexual Assault Victims Diagnosed with STDs Less Likely to Receive Treatment

The Centers for Disease Control and Prevention (CDC)'s updated guidelines for treating survivors of sexual assault include recommendations for treating them appropriately and minimizing further trauma. Women who have been forced to have sex are at greater risk for sexually transmitted diseases (STDs) than other women, but they are also less likely to be treated for their illness, according to study results presented at the 2016 CDC STD Prevention Conference in Atlanta.

"Overall, 19.5% of the women experienced forced sex in their life, which is consistent with what we saw in the literature, that about 1 in every 5 women experienced forced sex," Dr. Oscar Beltran, a research fellow in the Division of Sexually Transmitted Disease Prevention at CDC, said in his session at the conference.

"Sexual violence against women is a great issue right now in the United States. We need to better understand the links between the experiences, diagnoses, and treatment of sexual violence so clinicians evaluating the sexual history of their patients can identify the women at higher risk and give them timely referrals to interventions and programs that can assist them," he told Contagion^®.

Survivors of sexual assault should be examined by an experienced clinician who chooses to obtain genital or other specimens for STD diagnosis based on the individual survivor. Care systems for survivors should deliver continuity of care, including timely test results, support, and monitoring of any adverse reactions to treatment.

Dr. Beltran, a research fellow, and his co-authors Drs. Kate Brookmeyer and Neetu Abad, behavioral scientists in the Division of Sexually Transmitted Diseases in Atlanta, investigated how STD treatment pathways may be altered for women who have been coerced into sex.

They collected 2011 through 2013 data from the National Survey of Family Growth (NSFG) nationwide representative household survey of individuals aged 15 through 44 years, and they performed logistic regressions controlling for age, race/ethnicity, poverty level and education.

Overall, 25% of the 4962 women identified were 18 through 24 years of age; 38% were 25 through 34, and 37% were 35 through 44. A total of 20% of the women were Hispanic; 14% were non-Hispanic Black, 59% were non-Hispanic White, and 7% identified as other. A total of 11% of the women had not completed high school studies, 27% had graduated from high school or had completed their General Educational Development (GED) requirements, and 62% had education beyond high school.

For women 18 years of age and above who were sexually active, the researchers examined the links between forced vaginal intercourse perpetrated by anyone and the following conditions: risky sex (no condom use during most recent sex or 2 or more male partners in 12 months, no condom use at last sex, paid sex), risky partners (partner who is a man who has sex with men (MSM), an injection-drug user, or is HIV positive), and substance abuse (4 or more drinks within two hours within the last 30 days, use of cocaine, crack cocaine, crystal meth, or injection drugs within the last 12 months).

The researchers assessed the link between forced vaginal intercourse and lifetime diagnosis of herpes, syphilis, or genital warts; 12-month diagnosis of chlamydia or gonorrhea; and 12-month STD treatment.

After adjusting for demographics, women who were coerced into having sex were more likely to report risky sex (adjusted odds ratio (AOR) 1.56, 95% confidence interval (CI), 1.08 to 2.24), risky partners (AOR 1.90, 95% CI, 1.11 to 3.23), and substance abuse (AOR 1.80, 95% CI, 1.28 to 2.53).

Women who were forced to have sex were more likely to have had STD testing in the past 12 months (AOR 1.67 95% CI, 1.34 to 2.09).

Women forced to have sex were also more likely to ever be diagnosed with herpes (AOR 1.94, 95% CI, 1.13 to 3.32) and genital warts (AOR 2.55, 95% CI, 1.90 to 3.41) but were no more likely to be diagnosed with chlamydia, syphilis, or gonorrhea than women who were never coerced.

Women who were forced to have sex and were diagnosed with an STD were less likely to receive STD treatment compared with women who did not experience forced sex (AOR 1.44, 95% CI, 0.95 to 2.18).

The researchers noted that limitations to the study included its cross-sectional design that was based on a self-reported survey, the short time period involved, and the low number of syphilis and gonorrhea cases, which might have affected the results. The authors would like to conduct further related longitudinal studies.

"This study highlights the fact that sexual violence and STDs are major concerns in this country. We need to eliminate the barriers that women in danger have to seeking the care they need to protect themselves and maintain their health," Dr. Cheryl Kovar, assistant professor and director of the Nursing Leadership Concentration at East Carolina University College of Nursing in Greenville, North Carolina, said in an interview.

The CDC updated sexual assault, abuse, and STD guidelines are at https://www.cdc.gov/std/tg2015/sexual-assault.htm#riskHIV.

Lorraine L. Janeczko, MPH, is a medical science writer who creates news, continuing medical education and feature content in a wide range of specialties for clinicians, researchers and other readers. She has completed a Master of Public Health degree through the Department of Epidemiology of the Johns Hopkins Bloomberg School of Public Health and a Dana Postdoctoral Fellowship in Preventive Public Health Ophthalmology from the Wilmer Eye Institute, the Johns Hopkins University School of Medicine and the Bloomberg School.

DISCLOSURES: The authors and Dr. Kovar did not report any conflicts of interest with the study.

Sources:

• Sexual Assault and Abuse and STDs (https://www.cdc.gov/std/tg2015/sexual-assault.htm#riskHIV)
• 2016 CDC STD Prevention Conference p 95 (https://www.cdc.gov/stdconference/2016/STD_Conference_2016_Program_Book.pdf)
• Abstract 6C2: Understanding How Sexual Coercion Affects STD Treatment Pathways: Findings from the National Survey of Family Growth (2011-2013) https://cdc.confex.com/cdc/std2016/webprogram/Paper37531.html)