Women in the U.S. armed forces are diagnosed at significantly higher rates than men for most sexually transmitted diseases, but the greater incidence is likely tied to increased screening of female service members, a new report finds.
From 2013 to 2021, active-duty women were diagnosed with chlamydia at three times the rate as male service members. For gonorrhea, they tested positive at nearly 1.4 times the rate of males; for genital herpes, more than 4 times the rate; and human papillomavirus, 9 times the rate.
Yet men had a higher rate for syphilis: During the period, 5,128 servicemen, or five per 100,000 troops, were diagnosed with syphilis, compared with 734 women.
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"With the exception of syphilis, the crude overall incidence rates of all STIs [Sexually Transmitted Infections] were markedly higher among female than male service members," Armed Forces Surveillance Division analysts noted in the Defense Department's May Medical Surveillance Monthly Report, released Tuesday.
While the data could be construed to suggest that female service members are engaging in more risky behavior and thereby contracting infections at a higher rate, the study authors, echoing other public health experts, noted that across the services women are more widely screened for sexually transmitted infections than men.
Defense Department guidelines call for all potential recruits to be screened for HIV, while women at recruit training are also screened for chlamydia. They then are screened annually up to age 26 as part of their yearly gynecological exams.
"Higher incidence rates of most STIs among females compared to males can likely be attributed to implementation of the services' screening programs for STIs among female service members," the report stated. "Because asymptomatic infection with chlamydia, gonorrhea, or HPV [human papillomavirus] is common among sexually active females, widespread screening may result in sustained high numbers of infections diagnosed among young females."
Navy Lt. Karli Woollens, a family medicine specialist at the Navy Medicine Readiness and Training Command Bremerton supporting Naval Hospital Bremerton, Washington, agreed.
"They are ... more likely to be screened and therefore diagnosed with STIs due to recommended screening programs for all asymptomatic sexually active young women and pregnant women," Woollens said in a Defense Health Agency press release.
The rates for each of the five illnesses have varied across the years, but chlamydia, an infection that can go undetected but has the potential to cause infertility in women, remains the most common STI among service members.
The report authors noted some positive findings beginning in 2019: From that year through 2021, the rates actually declined for all illnesses except for syphilis for all service members.
Occurrences of chlamydia for both genders were greater than the total of the other four most common sexually transmitted diseases combined, according to the report.
Chlamydia infections rose in the U.S. nationwide by 19% from 2015 to 2019, according to the Defense Health Agency, but the illness is not the most common sexually transmitted illness in the country. That title goes to human papillomavirus, or HPV, cases of which have seen a steady decline among military men since 2013 and military women since 2015, according to the report.
That decline may be attributable to the availability of an HPV vaccine, which is not mandatory in the military but is encouraged by physicians for adolescents prior to joining the military and by military officials as well, the report noted.
The study, which reviewed DoD medical data and reports to the division, did not include any data on sexual behaviors, but noted that some military personnel have indicated in behavioral surveys that they engage in potentially risky sex.
The 2018 DoD Health Related Behaviors Survey noted that nearly 35% of those who responded had sex with a new partner without using a condom.
That figure was nearly double the rate reported in 2011.
According to the new report, nearly 360,000 troops were diagnosed with a sexually transmitted disease between 2013 and 2021. That included 233,886 cases of chlamydia, 37,592 cases of gonorrhea, 5,862 cases of syphilis, 27,238 cases of genital herpes and 55,040 cases of HPV.
Across the services, rates for chlamydia, gonorrhea and genital herpes simplex virus were highest in the Army. The Navy had the highest overall rate of syphilis and HPV.
For all illnesses except HPV, junior enlisted personnel, up to E-3, had the highest incidence rates. Junior officers through O-3 had the highest incidence rate of HPV.
Among military occupational specialties, motor transport personnel were diagnosed with chlamydia, gonorrhea and syphilis at the highest rates, while those in health care specialties had the highest rates of herpes and HPV.
The report noted that data was not included from five military medical facilities using the MHS Genesis electronic medical records system from July 2017 to October 2019, mainly locations in the Pacific Northwest.
The researchers said adherence to standards for screening, testing, treatment and reporting would improve efforts to detect and characterize health threats related to sexually transmitted diseases, while continued efforts to emphasize risk reduction could further decrease diagnoses.
-- Patricia Kime can be reached at Patricia.Kime@Military.com. Follow her on Twitter @patriciakime
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