Health of Transgender Women: Gynecological, Hormonal, Sexual and Psychological Management

healthtransgenderwomenkapak

SEXUALLY TRANSMITTED DISEASES IN TRANSGENDER WOMEN AND PREVENTION

Esra Ayanoğlu

Prof. Dr. İlhan Varank Sancaktepe Training and Research Hospital, Department of Gynecology and Obstetrics, İstanbul, Türkiye

Ayanoğlu E. Sexually Transmitted Diseases in Transgender Women and Prevention. Balsak D, Aksin Ş, eds. Health of Transgender Women: Gynecological, Hormonal, Sexual and Psychological Management. 1st ed. Ankara: Türkiye Klinikleri; 2025. p.237-253.

ABSTRACT

Transgender women (TGW) face unique challenges that contribute to a disproportionately high prevalence of sexually transmitted infections (STIs). Factors such as anatomical variations from gender-affirming surgeries, behavioral risks, and systemic healthcare barriers increase susceptibility to infections, including HIV, bacterial STIs like chlamydia, gonorrhea, and syphilis, as well as HPV-related conditions. Comprehensive prevention strategies emphasize vaccination, consistent condom use, and biomedical interventions like pre-exposure (PrEP) and post-exposure prophylaxis (PEP). Routine and risk-based STI screening is critical, particularly for extragenital infections and neovaginal health. Approaches must incorporate anatomical adaptations and trauma-informed practices to ensure patient comfort and accuracy in diagnosis. Neovaginal tissue characteristics, influenced by surgical techniques, play a role in susceptibility to specific infections, underscoring the importance of tailored screening protocols. Culturally competent care and the use of gender-affirming practices are essential to overcoming stigma, ensuring equitable access to healthcare, and addressing disparities in treatment outcomes. By integrating these strategies, healthcare providers can improve sexual health outcomes, reduce infection rates, and support the overall well-being of transgender women.

Keywords: Sexually transmitted diseases; Transgender persons; Patient-centered care; HIV infections; Health services for transgender persons

Referanslar

  1. Tanenbaum GJ, Holden LR. A review of patient experiences and provider education to improve transgender health inequities in the USA. International Journal of Environmental Research and Public Health. 2023;20(20):6949. [Crossref]  [PubMed]  [PMC]
  2. Herman JL, Flores AR, O'Neill KK. How many adults and youth identify as transgender in the United States? The Williams Institute, UCLA School of Law. 2022. [Link]
  3. Coleman E, Radix AE, Bouman WP, et al. Standards of care for the health of transgender and gender diverse people, Version 8. International Journal of Transgender Health. 2022;23(Suppl 1):S1-259. [Crossref]  [PubMed]  [PMC]
  4. T'Sjoen G, Arcelus J, Gooren L, et al. Endocrinology of transgender medicine. Endocrine Reviews. 2019;40(1):97-117. [Crossref]  [PubMed]
  5. Van Gerwen OT, Jani A, Long DM, et al. Prevalence of sexually transmitted infections and human immunodeficiency virus in transgendered persons: a systematic review. Transgender Health. 2020;5:90-103. [Crossref]  [PubMed]  [PMC]
  6. Tordoff DM, Dombrowski JC, Ramchandani MS, et al. Trans-inclusive sexual health questionnaire to improve human immunodeficiency virus/sexually transmitted infection (STI) care for transgender patients: anatomic site-specific STI prevalence and screening. Clinical Infectious Diseases.2023;76:736-43. [Crossref]  [PubMed]  [PMC]
  7. Brown EE, Patel EU, Poteat TC, et al. Prevalence of sexually transmitted infections among transgender women with and without HIV in the Eastern and Southern United States. Journal of Infectious Diseases. 2024;229:1614-27. [Crossref]  [PubMed]  [PMC]
  8. Pitasi MA, Kerani RP, Kohn R, et al. Chlamydia, gonorrhea, and human immunodeficiency virus infection among transgender women and transgender men attending clinics providing sexually transmitted disease services in six U.S. cities: Results from the sexually transmitted disease surveillance network. Sexually Transmitted Diseases. 2019;46:112-7. [Crossref]  [PubMed]  [PMC]
  9. MacCarthy S, Poteat T, Xia Z, Roque NL, Baral S, Reisner SL. Current research gaps: a global systematic review of HIV and sexually transmissible infections among transgender populations. Sexual Health. 2017;14:456-68. [Crossref]  [PubMed]  [PMC]
  10. Poteat T, Scheim A, Xavier J, Reisner S, Baral S. Global epidemiology of HIV infection and related syndemics affecting transgender people. Journal of Acquired Immune Deficiency Syndromes. 2016;72(Suppl 3):S210-9. [Crossref]  [PubMed]  [PMC]
  11. Cerwenka S, Nieder TO, Cohen-Kettenis P, De Cuypere G, Haraldsen IRH, Kreukels BP, et al. Sexual behavior of gender-dysphoric individuals before gender-confirming interventions: a European multicenter study. Journal of Sex & Marital Therapy. 2014;40(5):457-71. [Crossref]  [PubMed]
  12. Costantino A, Cerpolini S, Alvisi S, Morselli PG, Venturoli S, Meriggiola MC. A prospective study on sexual function and mood in female-to-male transsexuals during testosterone administration and after sex reassignment surgery. Journal of Sex & Marital Therapy. 2013;39(4):321-35. [Crossref]  [PubMed]
  13. Bungener SL, Steensma TD, Cohen-Kettenis PT, De Vries AL. Sexual and romantic experiences of transgender youth before gender-affirmative treatment. Pediatrics. 2017. [Crossref]  [PubMed]
  14. Sinha A, Goswami DN, Haldar D, Mallik S, Bisoi S, Karmakar PR. Sexual behavior of transgenders and their vulnerability to HIV/AIDS in an Urban Area of Eastern India. Indian J Public Health. 2017;61(2):141-143. [Crossref]  [PubMed]
  15. Wilson EC, Garofalo R, Harris DR, Belzer M. Sexual risk taking among transgender male-to-female youths with different partner types. American Journal of Public Health.2010;100(8):1500-5. [Crossref]  [PubMed]  [PMC]
  16. Nemoto T, Operario D, Keatley J, Villegas D. Social context of HIV risk behaviours among male-to-female transgenders of colour. AIDS Care. 2004;16(6):724-35. [Crossref]  [PubMed]
  17. Ragonnet-Cronin M, Hu YW, Morris SR, Sheng Z, Poortinga K, Wertheim JO. HIV transmission networks among transgender women in Los Angeles County, CA, USA: a phylogenetic analysis of surveillance data. The Lancet HIV.2019;6:e164-72. [Crossref]  [PubMed]
  18. Long JE, Tordoff DM, Reisner SL, et al. HIV transmission patterns among transgender women, their cisgender male partners, and cisgender MSM in Lima, Peru: a molecular epidemiologic and phylodynamic analysis. The Lancet Regional Health - Americas. 2022;6:100121. [Crossref]  [PubMed]  [PMC]
  19. Reisner SL, Poteat T, Keatley J, et al. Global health burden and needs of transgender populations: a review. The Lancet. 2016;388:412-36. [Crossref]  [PubMed]
  20. National Center for Transgender Equality. Testimony of the National Center for Transgender Equality, U.S. House of Representatives-Committee on the Judiciary, Subcommittee on the Constitution, Civil Rights, and Civil Liberties, H.R. 5 "The Equality Act"-April 2, 2019. [Link]
  21. Hines DD, Draucker CB, Habermann B. HIV testing and entry to care among trans women in Indiana. Journal of the Association of Nurses in AIDS Care. 2017;28(5):723-36. [Crossref]  [PubMed]  [PMC]
  22. Shankle M. The handbook of lesbian, gay, bisexual, and transgender public health: a practitioner's guide to service. New York: Routledge; 2013. [Crossref]  [PMC]
  23. Grant JM, Mottet LA, Tanis J, Herman JL, Harrison J, Keisling M. National transgender discrimination survey report on health and health care. Washington, DC: National Center for Transgender Equality and the National Gay and Lesbian Task Force; 2010. [Link]
  24. Hembree WC, Cohen-Kettenis PT, Gooren L, et al. Endocrine treatment of gender-dysphoric/gender-incongruent persons: an Endocrine Society clinical practice guideline. Journal of Clinical Endocrinology & Metabolism.2017;102(11):3869-903. Erratum in: Journal of Clinical Endocrinology & Metabolism. 2018;103(2):699. Erratum in: Journal of Clinical Endocrinology & Metabolism.2018;103(7):2758-9. [PubMed]
  25. Wascher J, Hazra A, Fisher AR. Sexual health for transgender and gender diverse individuals: routine examination, sexually transmitted infection screening, and prevention. Obstetrics and Gynecology Clinics of North America. 2024;51(2):405-24. [Crossref]  [PubMed]
  26. Valentine SE, Peitzmeier SM, King DS, O'Cleirigh C, Marquez SM, Presley C, et al. Disparities in exposure to intimate partner violence among transgender/gender nonconforming and sexual minority primary care patients. LGBT Health. 2017;4:260-7. [Crossref]  [PubMed]  [PMC]
  27. Poteat T. Transgender people and sexually transmitted infections (STIs). In: Guidelines for the primary and gender-affirming care of transgender and gender nonbinary people. 2nd ed. San Francisco: Center of Excellence for Transgender Health, Department of Family and Community Medicine, University of California; 2016. [Link]
  28. Gorfinkel MD, Perlow E, Macdonald S. The trauma-informed genital and gynecologic examination. Canadian Medical Journal. 2021;193:E1090. [Crossref]  [PubMed]  [PMC]
  29. Kelly-Hanku A, Bell S, Ase S, et al. Developing a culturally appropriate illustrated tool for the self-collection of anorectal specimens for the testing of sexually transmitted infections: lessons from Papua New Guinea. BMC Public Health. 2019;19:1. [Crossref]  [PubMed]  [PMC]
  30. Weyers S, De Sutter P, Hoebeke S, Monstrey G, T'Sjoen G, Verstraelen H, et al. Gynaecological aspects of the treatment and follow-up of transsexual men and women. Facts, Views & Vision in ObGyn. 2010;2(1):35-54. [PubMed]
  31. Cornelisse VJ, Jones RA, Fairley CK, Grover SR. The medical care of the neovagina of transgender women: a review. Sexual Health. 2017;14(5):442-50. [Crossref]  [PubMed]
  32. Van Gerwen OT, Aryanpour Z, Selph JP, Muzny CA. Anatomical and sexual health considerations among transfeminine individuals who have undergone vaginoplasty: a review. International Journal of STD & AIDS. 2021;33(2):106-13. [Crossref]  [PubMed]  [PMC]
  33. Workowski KA, Bachmann LH, Chan PA, Johnston CM, Muzny CA, Park I, Reno H, Zenilman JM, Bolan GA. Sexually transmitted infections treatment guidelines, 2021. Morbidity and Mortality Weekly Report Recommendations and Reports. 2021;70(4). [Crossref]  [PubMed]  [PMC]
  34. Hiransuthikul A, Janamnuaysook R, Sungsing T, et al. High burden of chlamydia and gonorrhoea in pharyngeal, rectal, and urethral sites among Thai transgender women: Implications for anatomical site selection for the screening of STI. Sex Transm Infect. 2019;95(7):534. [Crossref]  [PubMed]
  35. Reisner SL, Radix A, Deutsch MB. Integrated and gender-affirming transgender clinical care and research. J Acquir Immune Defic Syndr. 2016;72(Suppl 3):S235-S242. [Crossref]  [PubMed]  [PMC]
  36. Scheim AI, Travers R. Barriers and facilitators to HIV and sexually transmitted infections testing for gay, bisexual, and other transgender men who have sex with men. AIDS Care. 2017;29(8):990-995. [Crossref]  [PubMed]
  37. Fiumara NJ, Asvadi S. Asymptomatic gonococcal urethritis in a male transsexual female. Br J Vener Dis. 1978;54(2):130-1. [Crossref]  [PubMed]  [PMC]
  38. Fiumara NJ, Di Mattia A. Gonorrhoea and condyloma acuminata in a male transsexual. Br J Vener Dis. 1973;49(5):478-479. [Crossref]  [PubMed]  [PMC]
  39. Radix AE, Harris AB, Belkind U, et al. Chlamydia trachomatis Infection of the Neovagina in Transgender Women. Open Forum Infect Dis. 2019;6(ofz470). [Crossref]  [PubMed]  [PMC]
  40. Slater MW, Vinaja X, Aly I, et al. Neovaginal construction with pelvic peritoneum: Reviewing an old approach for a new application. Clin Anat. 2018;31(2):175-180. [Crossref]  [PubMed]
  41. Haustein UF. [Pruritus of the artificial vagina of a transsexual patient caused by gonococcal infection]. Hautarzt. 1995;46(12):858-859. [Crossref]  [PubMed]
  42. Bodsworth NJ, Price R, Davies SC. Gonococcal infection of the neovagina in a male-to-female transsexual. Sex Transm Dis. 1994;21(4):211-212. [Crossref]  [PubMed]
  43. van der Sluis WB, Bouman MB, Gijs L, van Bodegraven AA. Gonorrhoea of the sigmoid neovagina in a male-tofemale transgender. Int J STD AIDS. 2015;26(8):595-598. [Crossref]  [PubMed]
  44. Crowell TA, Lawlor J, Lombardi K, et al. Anorectal and Urogenital Mycoplasma genitalium in Nigerian Men Who Have Sex With Men and Transgender Women: Prevalence, Incidence, and Association With HIV. Sex Transm Dis. 2020;47(3):202-206. [Crossref]  [PubMed]  [PMC]
  45. Borawski KM. . Sexually Transmitted Infections. In A. W. Partin, R. R. Dmochowski, & L. R. Kavoussi (Eds.), Campbell-Walsh-Wein Urology (2020, 12th ed., pp. 1251-1272). Elsevier. [Link]
  46. Jensen JS, Cusini M, Gomberg M, Moi H, Wilson J, Unemo M. 2021 European guideline on the management of Mycoplasma genitalium infections. J Eur Acad Dermatol Venereol. 2022;36(5):641-650. [Crossref]  [PubMed]
  47. Xavier Hall CD, Ryan D, Hayford C, et al. Syphilis Prevalence, Incidence, and Demographic Differences in a Longitudinal Study of Young Sexual and Gender Minority Adults Assigned Male at Birth. J Infect Dis. 2024;229(1):232-236. [Crossref]  [PubMed]  [PMC]
  48. Janier M, Unemo M, Dupin N, Tiplica GS, Potočnik M, Patel R. 2020 European guideline on the management of syphilis. J Eur Acad Dermatol Venereol. 2021;35(3):574-588. [Crossref]  [PubMed]
  49. Chesson HW, Heffelfinger JD, Voigt RF. Estimates of primary and secondary syphilis rates in persons with HIV in the United States. Sexually Transmitted Diseases, 2005;32(5):265-269. [Crossref]  [PubMed]
  50. Sahastrabuddhe S, Gupta A, Stuart E, et al. Sexually transmitted infections and risk behaviors among transgender persons (Hijras) of Pune, India. J Acquir Immune Defic Syndr. 2012;59(1):72-78. [Crossref]  [PubMed]
  51. Baral SD, Poteat T, Strömdahl S, Wirtz AL, Guadamuz TE, Beyrer C. Worldwide burden of HIV in transgender women: a systematic review and meta-analysis. Lancet Infect Dis. 2013;13(3):214-222. [Crossref]  [PubMed]
  52. Jenness SM, Begier EM, Neaigus A, Murrill CS, Wendel T, Hagan H. Unprotected anal intercourse and sexually transmitted diseases in high-risk heterosexual women. Am J Public Health. 2011;101(4):745-750. [Crossref]  [PubMed]  [PMC]
  53. Poteat T, Wirtz AL, Radix A, et al. HIV risk and preventive interventions in transgender women sex workers. Lancet. 2015;385(9964):274-286. [Crossref]  [PubMed]
  54. Robb ML, Eller LA, Kibuuka H, et al. Prospective Study of Acute HIV-1 Infection in Adults in East Africa and Thailand. N Engl J Med. 2016;374(22):2120-2130. [Crossref]  [PubMed]  [PMC]
  55. Daar ES, Little S, Pitt J, et al. Diagnosis of primary HIV-1 infection. Los Angeles County Primary HIV Infection Recruitment Network. Ann Intern Med. 2001;134(1):25-29. [Crossref]  [PubMed]
  56. Braun DL, Kouyos RD, Balmer B, Grube C, Weber R, Günthard HF. Frequency and Spectrum of Unexpected Clinical Manifestations of Primary HIV-1 Infection. Clin Infect Dis.2015;61(6):1013-1021. [Crossref]  [PubMed]
  57. Daar ES, Pilcher CD, Hecht FM. Clinical presentation and diagnosis of primary HIV-1 infection. Curr Opin HIV AIDS. 2008;3(1):10-15. [Crossref]  [PubMed]
  58. Branson, B. M., Owen, S. M., Wesolowski, L. G., Bennett, B., Werner, B. G., Wroblewski, K. E., & Pentella, M. A. (2014). Laboratory testing for the diagnosis of HIV infection: Updated recommendations. Centers for Disease Control and Prevention (CDC), National Center for HIV/AIDS, Viral Hepatitis, and TB Prevention, Division of HIV/AIDS Prevention. [Link]
  59. Radix AE. Management and Prevention of HIV Among Transgender Adults. Top Antivir Med. 2020;28(3):474-478. [PubMed]
  60. Panel on Antiretroviral Guidelines for Adults and Adolescents. Guidelines for the Use of Antiretroviral Agents in Adults and Adolescents With HIV. Department of Health and Human Services; 2024. [Link]
  61. Gandhi RT, Landovitz RJ, Sax PE, et al. Antiretroviral Drugs for Treatment and Prevention of HIV in Adults: 2024 Recommendations of the International Antiviral Society-USA Panel. JAMA. Published online December 1, 2024. [Crossref]  [PubMed]
  62. Safer JD, Tangpricha V. Care of the Transgender Patient. Ann Intern Med. 2019;171(1):ITC1-ITC16. [Crossref]  [PubMed]
  63. Fernandez JD, Tannock LR. Metabolic effects of hormone therapy in transgender patients. Endocr Pract. 2016;22(4):383-388. [Crossref]  [PubMed]  [PMC]
  64. Graham SM, Barthold D, Hauber B, et al. U.S. patient preferences for long-acting HIV treatment: a discrete choice experiment. J Int AIDS Soc. 2023;26 Suppl 2(Suppl 2):e26099. [Crossref]  [PubMed]  [PMC]
  65. Swindells S, Andrade-Villanueva JF, Richmond GJ, et al. Long-Acting Cabotegravir and Rilpivirine for Maintenance of HIV-1 Suppression. N Engl J Med. 2020;382(12):1112-1123. [Crossref]  [PubMed]
  66. Orkin C, Arasteh K, Górgolas Hernández-Mora M, et al. Long-Acting Cabotegravir and Rilpivirine after Oral Induction for HIV-1 Infection. N Engl J Med. 2020;382(12):1124-1135. [Crossref]  [PubMed]
  67. Kremer IEH, Beaudart C, Simons J, Plieger H, Schroeder M, Hiligsmann M. Preferences of people living with HIV for injectable and oral antiretroviral treatment in the Netherlands: a discrete choice experiment. AIDS Care.2024;36(4):536-545. [Crossref]  [PubMed]
  68. Margolis DA, Gonzalez-Garcia J, Stellbrink HJ, et al. Long-acting intramuscular cabotegravir and rilpivirine in adults with HIV-1 infection (LATTE-2): 96-week results of a randomised, open-label, phase 2b, non-inferiority trial. Lancet. 2017;390(10101):1499-1510. [Crossref]  [PubMed]
  69. Slama L, Porcher R, Linard F, et al. Injectable long acting antiretroviral for HIV treatment and prevention: perspectives of potential users. BMC Infect Dis. 2023;23(1):98. Published 2023 Feb 17. [Crossref]  [PubMed]  [PMC]
  70. van der Sluis WB, Buncamper ME, Bouman MB, et al. Symptomatic HPV-related neovaginal lesions in transgender women: case series and review of literature. Sex Transm Infect. 2016;92(7):499-501. [Crossref]  [PubMed]
  71. Liguori G, Trombetta C, Bucci S, et al. Condylomata acuminata of the neovagina in a HIV-seropositive male-to-female transsexual. Urol Int. 2004;73(1):87-88. [Crossref]  [PubMed]
  72. Jalil EM, Wilson EC, Monteiro L, et al. High prevalence of anal high-risk HPV infection among transwomen: estimates from a Brazilian RDS study. J Int AIDS Soc.2021;24(3):e25691. [Crossref]  [PubMed]  [PMC]
  73. Matsuki S, Kusatake K, Hein KZ, Anraku K, Morita E. Condylomata acuminata in the neovagina after male-to-female reassignment treated with CO2 laser and imiquimod. Int J STD AIDS. 2015;26(7):509-511. [Crossref]  [PubMed]
  74. Yang C, Liu S, Xu K, Xiang Q, Yang S, Zhang X. Condylomata gigantea in a male transsexual. Int J STD AIDS. 2009;20(3):211-212. [Crossref]  [PubMed]
  75. Wasef W, Sugunendran H, Alawattegama A. Genital warts in a transsexual. Int J STD AIDS. 2005;16(5):388-389. [Crossref]  [PubMed]
  76. Hernon M, Sloan H, Thompson R, De Cruze B, Sanders C, Creighton SM. Should we vaccinate against and test for human papillomavirus infection in adolescent girls and women with a neovagina?. J Fam Plann Reprod Health Care.2014;40(3):161-164. [Crossref]  [PubMed]
  77. Giannou FK, Tsiara CG, Nikolopoulos GK, et al. Condom effectiveness in reducing heterosexual HIV transmission: a systematic review and meta-analysis of studies on HIV serodiscordant couples. Expert Rev Pharmacoecon Outcomes Res. 2016;16(4):489-499. [Crossref]  [PubMed]
  78. Fleming DT, Wasserheit JN. From epidemiological synergy to public health policy and practice: the contribution of other sexually transmitted diseases to sexual transmission of HIV infection. Sex Transm Infect. 1999;75(1):3-17. [Crossref]  [PubMed]  [PMC]
  79. Stillwaggon E, Sawers L. Rush to judgment: the STI-treatment trials and HIV in sub-Saharan Africa. J Int AIDS Soc. 2015;18(1):19844. Published 2015 May 18. [Crossref]  [PubMed]  [PMC]
  80. Barajas-Nava L. Oral Substitution Treatment of Injecting Opioid Users for Prevention of HIV Infection. J Assoc Nurses AIDS Care. 2017;28(5):832-833. [Crossref]  [PubMed]
  81. Stoltz JA, Wood E, Small W, et al. Changes in injecting practices associated with the use of a medically supervised safer injection facility. J Public Health (Oxf). 2007;29(1):35-39. [Crossref]  [PubMed]
  82. Altice FL, Bruce RD, Lucas GM, et al. HIV treatment outcomes among HIV-infected, opioid-dependent patients receiving buprenorphine/naloxone treatment within HIV clinical care settings: results from a multisite study. J Acquir Immune Defic Syndr. 2011;56 Suppl 1(Suppl 1):S22-S32. [Crossref]  [PubMed]  [PMC]
  83. Centers for Disease Control and Prevention. US Public Health Service: Preexposure prophylaxis for the prevention of HIV infection in the United States- 2021 Update: a clinical practice guideline. 2021. [Link]
  84. Grant RM, Anderson PL, McMahan V, et al. Uptake of pre-exposure prophylaxis, sexual practices, and HIV incidence in men and transgender women who have sex with men: a cohort study. Lancet Infect Dis. 2014;14(9):820-829. [Crossref]  [PubMed]
  85. Volk JE, Marcus JL, Phengrasamy T, et al. No New HIV Infections With Increasing Use of HIV Preexposure Prophylaxis in a Clinical Practice Setting. Clin Infect Dis.2015;61(10):1601-1603. [Crossref]  [PubMed]  [PMC]
  86. McCormack S, Dunn DT, Desai M, et al. Pre-exposure prophylaxis to prevent the acquisition of HIV-1 infection (PROUD): effectiveness results from the pilot phase of a pragmatic open-label randomised trial. Lancet. 2016;387(10013):53-60. [Crossref]  [PubMed]
  87. Marcus JL, Hurley LB, Nguyen DP, Silverberg MJ, Volk JE. Redefining Human Immunodeficiency Virus (HIV) Preexposure Prophylaxis Failures. Clin Infect Dis. 2017;65(10):1768-1769. [Crossref]  [PubMed]  [PMC]
  88. Mayer KH, Molina JM, Thompson MA, et al. Emtricitabine and tenofovir alafenamide vs emtricitabine and tenofovir disoproxil fumarate for HIV pre-exposure prophylaxis (DISCOVER): primary results from a randomised, double-blind, multicentre, active-controlled, phase 3, non-inferiority trial. Lancet. 2020;396(10246):239-254. [Crossref]  [PubMed]
  89. Spinner C, Avery A, Flamm JA, Crofoot G, Brinson C, Kronborg, et al. Outcomes of participants switching from F/TDF to F/TAF for PrEP: week 48 results from the DISCOVER open label phase. Journal of the International AIDS Society, 2021;24(S4):29-30. [Link]
  90. Landovitz RJ, Donnell D, Clement ME, et al. Cabotegravir for HIV Prevention in Cisgender Men and Transgender Women. N Engl J Med. 2021;385(7):595-608. [Crossref]  [PubMed]  [PMC]
  91. Delany-Moretlwe S, Hughes JP, Bock P, et al. Cabotegravir for the prevention of HIV-1 in women: results from HPTN084, a phase 3, randomised clinical trial [published correction appears in Lancet. 2022 May 7;399(10337):1778.Lancet. [PubMed]
  92. Tsai CC, Emau P, Follis KE, et al. Effectiveness of postinoculation (R)-9-(2-phosphonylmethoxypropyl) adenine treatment for prevention of persistent simian immunodeficiency virus SIVmne infection depends critically on timing of initiation and duration of treatment. J Virol. 1998;72(5):4265-4273. [Crossref]  [PubMed]  [PMC]
  93. Dominguez KL, et al. Updated Guidelines for Antiretroviral Postexposure Prophylaxis After Sexual, Injection Drug Use, or Other Nonoccupational Exposure to HIV-United States, 2016. [Link]
  94. Brown B, Galea JT, Byraiah G, et al. Anogenital Human Papillomavirus Infection and HIV Infection Outcomes Among Peruvian Transgender Women: Results from a Cohort Study. Transgend Health. 2016;1(1):94-98. Published 2016 May 1. [Crossref]  [PubMed]  [PMC]
  95. Fernandes HM, Manolitsas TP, Jobling TW. Carcinoma of the neovagina after male-to-female reassignment. J Low Genit Tract Dis. 2014;18(2):E43-E45. [Crossref]  [PubMed]
  96. Wang G, Ferguson D, Ionescu DN, et al. HPV-Related Neovaginal Squamous Cell Carcinoma Presenting as Lung Metastasis after Male-to-Female Gender Confirmation Surgery. Case Rep Oncol. 2020;13(1):17-22. [Crossref]  [PubMed]  [PMC]
  97. Fierz R, Ghisu GP, Fink D. Squamous Carcinoma of the Neovagina after Male-to-Female Reconstruction Surgery: A Case Report and Review of the Literature. Case Rep Obstet Gynecol. 2019;2019:4820396. [Crossref]  [PubMed]  [PMC]
  98. Markowitz LE, Dunne EF, Saraiya M, et al. Human papillomavirus vaccination: recommendations of the Advisory Committee on Immunization Practices (ACIP). MMWR Recomm Rep. 2014;63(RR-05):1-30. [PubMed]
  99. Meites E, Kempe A, Markowitz LE. Use of a 2-Dose Schedule for Human Papillomavirus Vaccination - Updated Recommendations of the Advisory Committee on Immunization Practices. MMWR Morb Mortal Wkly Rep. 2016;65(49):1405-1408. [Crossref]  [PubMed]
  100. Singh V, Gratzer B, Gorbach PM, et al. Transgender Women Have Higher Human Papillomavirus Prevalence Than Men Who Have Sex With Men-Two U.S. Cities, 2012-2014. Sex Transm Dis. 2019;46(10):657-662. [Crossref]  [PubMed]  [PMC]
  101. Bachmann LH, Barbee LA, Chan P, et al. CDC Clinical Guidelines on the Use of Doxycycline Postexposure Prophylaxis for Bacterial Sexually Transmitted Infection Prevention, United States, 2024. MMWR Recomm Rep. 2024;73(2):1-8. [Crossref]  [PubMed]  [PMC]
  102. Molina JM, Charreau I, Chidiac C, et al. Post-exposure prophylaxis with doxycycline to prevent sexually transmitted infections in men who have sex with men: an open-label randomised substudy of the ANRS IPERGAYtrial. Lancet Infect Dis. 2018;18(3):308-317. [Crossref]  [PubMed]
  103. Luetkemeyer AF, Donnell D, Dombrowski JC, et al. Postexposure Doxycycline to Prevent Bacterial Sexually Transmitted Infections. N Engl J Med. 2023;388(14):1296-1306. [Crossref]  [PubMed]  [PMC]