Active duty military women may have higher STI risk

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.

"(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.