This article is more than 5 years old. Information may no longer be current.
Neovaginal chlamydia documented for first time in transgender women
Click Here to Manage Email Alerts
Researchers documented what are believed to be the first reported cases of neovaginal chlamydia in two transgender women who had recently undergone vaginoplasty, according to a recently published report.
“Although chlamydia infections have previously been reported in transgender women, these have all been anal or urethral infections. These are the first published case reports describing neovaginal infection,” Asa E. Radix, MD, MPH, senior director of research and education at the Callen-Lorde Community Health Center in New York, told Infectious Disease News.
According to the report, which was published in Open Forum Infectious Diseases, the cases of Chlamydia trachomatis infection were in transgender women who underwent penile-inversion vaginoplasty with integrated peritoneum and urethral grafts.
The first patient was a 21-year-old, HIV-negative transgender woman who presented with vaginal irritation, discharge and malodor in January 2019, 4 months after her surgery. According to the report, she had several cisgender male sexual partners after surgery and used condoms for anal receptive sex but not for vaginal or oral sex. A urine sample was positive for C. trachomatis.
The second patient was in a 32-year-old, HIV-negative transgender woman who presented for routine asymptomatic STI screening in March 2018. According to researchers, she had undergone a vaginoplasty 5 months before the screening and was postoperatively treated for neovaginal granulation tissue and stress incontinence. According to the report, she had condomless vaginal receptive sex with cisgender men but denied oral or anal sex. Both a urine and a vaginal swab tested positive for C. trachomatis.
Radix and colleagues said the tissue types associated with the integrated peritoneum and urethral grafts may have facilitated the C. trachomatis infection.
“I would not consider this scary,” Radix said. “Transgender women will not have the serious sequelae that can occur in cisgender women, such as pelvic inflammatory disease, infertility and ectopic pregnancy.”
Moving forward, screening and treatment will be important for the patients and to prevent ongoing transmission of infection to sexual partners, he said.
“Clinicians should screen anatomic sites that may be exposed to STIs, including neovaginal screening in transgender women,” Radix said. “The new penile-inversion vaginoplasty procedures that include peritoneal or mucosal grafts may increase susceptibility to STIs, but we still need further research in this area.” – by Caitlyn Stulpin
Disclosure: Radix reports no relevant financial disclosures.
Perspective
Back to Top
Tonia Poteat, PhD, MPH, PA-C
Despite well-documented disparities in STI burden among transgender women, remarkably little empiric research has been published about the risk for infection in the neovagina. Because public and private insurers remove exclusions for gender-affirming medical interventions, an increasing number of transgender women have gained access to vaginoplasty. Therefore, it is important for all clinicians who provide care for transgender women to understand how best to promote neovaginal health. Radix and colleagues advance knowledge in this area by demonstrating neovaginal STI vulnerability among transgender women who have had vaginoplasty that includes incorporation of mucosal or peritoneal tissue.
These case reports are important in reminding us of several important elements of providing quality care for transgender women. First, a detailed surgical history that includes tissue types used for vaginal construction is essential for understanding STI susceptibility. Second, screening for STIs in multiple sites of potential exposure is critical for ensuring we do not miss a treatable infection. Third, transgender women may selectively use condoms for some types of sex and not others. Therefore, questions about condom use need to be specific. Finally, because sensitivity of neovaginal swabs vs. urine samples for STI detection has not been established, it may be useful to collect both until further research provides clarity. For researchers, this manuscript reminds us how much still needs to be learned to support evidence-informed, quality care for transgender people.
Click Here to Manage Email Alerts