Gender Differences in Bacterial STIs in Canada

Abstract

Health Issue: The incidence of bacterial sexually transmitted infections (STIs) is rising in Canada. If these curable infections were prevented and treated, serious long-term sequelae including infertility, and associated treatment costs, could be dramatically reduced. STIs pose a greater risk to women than men in many ways, and further gender differences exist in screening and diagnosis.Key Findings: Reported incidence rates of chlamydia, gonorrhea, and infectious syphilis declined until 1997, when the trend began to reverse. The reported rate of chlamydia is much higher among women than men, whereas the reverse is true for gonorrhea and infectious syphilis. Increases in high-risk sexual behaviour among men who have sex with men were observed after the introduction of potent HIV suppressive therapy in 1996, but behavioural changes in women await further research. Data Gaps and Recommendations:STI surveillance in Canada needs improvement. Reported rates underestimate the true incidence. Gender-specific behavioural changes must be monitored to enhance responsiveness to groups at highest risk, and more research is needed on effective strategies to promote safer sexual practices. Geographic and ethnic disparities, gaps, and needs must be addressed. Urine screening for chlamydia should be more widely available for women as well as men, particularly among high-risk men in order to prevent re-infections in their partners. As women are more likely to present for health examinations (e.g. Pap tests), these screening opportunities must be utilized. Female-controlled methods of STI prevention, such as safer topical microbicides, are urgently needed.

The utility and cost of Chlamydia trachomatis and Neisseria gonorrhoeae screening of a male infertility population

“…Our study is the first to compare the STI screening results of an infertile male population with the general population of the country of study. The findings of our study demonstrate that when infertile Canadian men are screened for CT and NG in the tertiary care setting, the positive rate is statistically significantly lower than that of the general population, even when the reported rates in the general population are an underestimate (33). There are limitations in comparing a largely unscreened, symptomatic general Canadian population with a screened male infertility population, but this comparison is important to note as it reiterates that infertile men presenting to a tertiary infertility clinic are at extremely low risk for CT/NG in the Canadian context.…”

Sex Differences in the Transmission, Prevention, and Disease Manifestations of Sexually Transmitted Diseases

“…38 Pelvic inflammatory disease is responsible for 15% of all infertility. 39 The increased risk is due not only to the greater mucosal surface area present in women but also to the exposed squamocolumnar epithelium of the cervical os in female adolescents, which is less resistant to these pathogens. 39 In vivo studies 20 of topical microbicides against vaginal chlamydia found promising results of significantly reduced infection.…”

The Preliminary Findings of a Study Exploring the Perceptions of a Sample of Young Heterosexual Males Regarding HIV Prevention Education Programming in Nova Scotia, Canada

“…However, healthy sexuality campaigns aimed at reducing HIV infection developed in the early years of the epidemic were developed ostensibly by and for gay men, more recently for "men who have sex with men," and were largely based on risk group categories (Centers of Disease Control 2006;Connell 2001;Murphy, Rotherman-Borus, and Reid 1998;Rotherman-Borus, Marelich, and Srinevasan 1999). As such, HIV prevention programs and services did not address the gender-based differences in sexual risk behaviours across all sectors of the population, particularly young heterosexuals in Canada (Canadian Public Health Association 2001;Gatali and Archibald 2004;Planned Parenthood Federation of Canada 2001;Wong et al 2004). …”