STD Information for Lesbians

Published on August 28 2008 No Comment

Below is a listing of STD’s and vaginal infections. We are focusing primarily on woman to woman transmission (WTW) and only providing a general overview of the infections themselves. If you feel you need further information, please consult your OB/GYN.

Allergic Vaginitis

Sometimes referred to as ‘chemical vaginitis,’ this condition is a great mimicker. Because it often affects not only the vagina itself but external tissues (the vulva), it is often mistaken for a yeast infection, or even new onset genital herpes. It’s due to genital contact with an irritant, the most common offending agents being latex or components of spermicides, lubricants, a new detergent/soap/bath gel, silicone sex toys, or ‘feminine’ deodorants. Anything that can cause an allergic skin reaction (like a rash) can cause a similar reaction on mucous membranes, including genital tissues.

  • Symptoms: red, painful or irritated or itching vulva; increased vaginal discharge. The vulva may have whitish or grayish striations or hue, along with some scaly skin.
  • Treatment: if you can figure out the offending substance, discontinue use. Antihistamines (Benadryl for example) may help relieve symptoms. Low-dose (0.5%) cortisone cream is also effective, but consult your health care provider before applying any steroid cream to the genital area.

Bacterial Vaginosis (BV)

BV is basically an imbalance of the normal bacteria that live in the vagina, most specifically in association with loss of the normal protective lactobacilli that normally live there in abundance. It is not clear what precisely causes BV; some researchers think women sex partners may actually transmit some undefined factor that causes it. Research continues on this question. We do know douching is a risk factor for BV (and douching is a bad idea in general). Join our BV study and help us find out what is up with this common condition!

  • Symptoms: gray to yellowish homogenous discharge, sometimes with a fishy odor, sometimes causing vulvar &/or vaginal irritation.
  • Transmission WTW: not clear. While one research article called BV a “STD among lesbians,” this has yet to be proven, and research is underway to look at this more closely. Whether or not partners should be evaluated or treated is not yet known.
    Join our new BV study! See Research for more information.
  • Treatment: antibiotic vaginal cream or oral medication (metronidazole or clindamycin). Over the counter lactobacilli supplements do not contain the specific kind of bacteria needed to replenish the vagina’s natural balance.


This STD is caused by bacteria transmitted to the vagina or rectum by contact with infected genital fluids. Chlamydia can infect the cervix, rectum or urethra (the passage through which urine exits the body) in women.

  • Symptoms: usually none. Sometimes slightly increased vaginal discharge, spotting, burning with urination, abnormal bleeding (especially after penetration).
  • Transmission WTW: theoretically possible but not yet studied.
  • Treatment: oral antibiotics.(Azithromycin, Doxycycline. Pregnant women: Amoxicillin or erythromycin) All partners should be treated.


This STD is caused by bacteria transmitted to the vagina, throat or rectum by exchanging infected genital fluids during sex.

  • Symptoms: often none. Occasionally, vaginal discharge—often yellow or yellow-green—and painful urination can occur, as can abnormal bleeding, especially after penetration.
  • Transmission WTW: theoretically possible but not yet studied.
  • Treatment: Antibiotics (oral:Cefixime, Ciprofloxacin, or Ofloxacin OR Ceftriaxone injection) Persons infected with gonorrhea are also treated for chlamydia. All partners should be treated.


Inflammation of the liver. Many potential causes, including drugs, toxins and viruses. Hepatitis A, B, & C are the three major viruses that cause hepatitis.

  • Symptoms: Often none. If symptoms do occur may include yellowing of skin & eyes, loss of appetite, nausea, stomach pain, extreme tiredness.
  • WTW transmission: Hepatitis A is transmitted by fecal matter either in contaminated food or by oral-anal contact. Transmission between female partners has been reported.
    Hepatitis B is transmitted by exchanging blood or body fluids. Touching an infected person’s open sore or cut if you yourself have any skin breaks, or sharing a razor, toothbrush or nail clipper, can permit transmission. Even small amounts of blood or other body fluids can spread the virus if direct contact occurs. *Hepatitis A is preventable by vaccination: ask your health provider!
    Hepatitis B is not spread by food, water or casual contact. Transmission between female partners has not been studied, but has occurred. *Hepatitis B is preventable by vaccination: ask your health provider!*
    Hepatitis C is transmitted primarily through contact with infected blood. Sexual transmission between men and women is relatively uncommon; WTW has not been studied.
  • Treatment: A complex issue. See our links for more information. .

Herpes (genital)

These infections are caused by the herpes simplex viruses (HSV-2 and HSV-1). Transmission can occur even when lesions are not present (in fact, probably most transmission actually occurs in the absence of skin ulcers or breakdown, which is why 90% of persons infected with HSV-2 don’t know they’re infected). See our Links for several excellent resources on this common infection.

  • Symptoms: small blisters on the vulva, often painful, are classic, but at least 90% of people infected with HSV-2, which causes the majority of genital herpes, do not know they are infected. Itching is a common symptom. In the initial episode of HSV, symptoms can include painful/difficult urination, fever, swollen lymph nodes, and flu-like symptoms.
  • Treatment: three antiviral medications (acyclovir, famciclovir, valacyclovir) are now available & all work equally well. Antivirals are also recommended for recurrences and suppression when there are more than 6 recurrences a year. Antivirals help the symptoms of HSV and speed healing; they do not cure the virus. They also reduce the likelihood that HSV is shed in the absence of outbreaks.
  • Transmission WTW: very likely occurs, but data on specific prevalence and risks is very limited. In particular, oral-genital contact (oral sex) can transmit HSV-1 from the mouth to the genital area, especially when one partner has a cold sore.
  • Precautions: because transmission can occur even when no lesions are present, any genital-genital contact should involve latex barriers 100% of the time; couples should abstain from sex during outbreaks, until the skin is fully healed.


AIDS is caused by the HIV virus. It is spread through direct contact with blood, semen, vaginal fluids, or breast milk, usually during sex, birth, or sharing needles. The HIV virus slowly attacks white blood cells which constitute a major part of the body’s immune system. White blood cells fight infections. When the immune system is weak, harmful germs & infections take over, and AIDS (acquired immunodeficiency syndrome) becomes evident.

  • Transmission WTW: while there is little research or documentation on this topic, the medical literature does have case reports of WTW sexual transmission of HIV. The most likely sources for transmission are menstrual blood, vaginal discharge when there is vaginitis (there are more white blood cells containing HIV present then), and traumatic sex practices. However, more research is urgently needed in this area; none of these mechanisms, or their relative risk, have been directly studied yet.
  • Prevention: Please see Practices section.
  • Treatment: There are numerous drug therapies to help the immune system and fight the HIV virus, though at this time there is no cure. Treatments are constantly changing so for the most up to date information we suggest visiting the San Francisco AIDS Foundation website and The Body website.

Human Papillomavirus (HPV)

HPV is probably the most common STD (some estimates say ~70% of all adults have evidence of previous infection), with most infected people never evidencing its two major effects: genital warts, and cervical neoplasia (pre cancerous or cancerous changes, detected as an abnormal Pap smear). It is an STD caused by skin or mucous membrane contact with an infected person. Different strains of HPV cause genital warts and cervical cancer.

  • Transmission WTW: very likely occurs, probably through direct contact of genital skin, or contamination of hands/fingers. The role of insertive sex toys is not known for sure, but it’s possible that HPV could be transmitted on shared toys not thoroughly cleansed between use in one (infected) partner and the next.
  • Treatment: if warts are present, the most common treatment is freezing using liquid nitrogen; more than one treatment may be required. There is no cure for the virus itself. Pap smears can detect HPV and cervical changes ; yearly exams are essential for all sexually active women, regardless of the gender of partners. Our research and others has shown that lesbians may be less likely to get Pap smears as frequently as they should. Get routine screening (every 1-2 years, depending on your Pap smear history) regardless of whether you have sex with men!

Pelvic Inflammatory Disease (PID)

An infection of the uterus, fallopian tubes and ovaries. Caused by many kinds of bacteria, but chlamydia and gonorrhea are the most common causes. It can also occur after childbirth, abortion, or surgery on the female organs. The infection usually starts 2 to 21 days after having sex with an infected person, but some infections do not start until several months later. PID can cause scar tissue that can block fallopian tubes causing infertility (after 1 PID infection 10% of women become infertile; 75% are infertile after 3 infections), tubal pregnancies (a woman is 7 times more likely to have a tubal pregnancy after PID), and abcesses. Some women continue to have lower abdominal pain for several months after PID.

  • Symptoms: Mild to severe abdominal pain, back pain, may have fever, nausea, bleeding between periods, pain with sex, vaginal discharge. Some women have no symptoms.
  • WTW Transmission: Transmission of the bacteria that cause PID is theoretically possible though not studied. A recent report did discuss PID occurring in two lesbians, in whom the diagnosis was initially missed because they were thought to be at ‘low risk’ for STD.
  • Treatment: Mild PID is treated with a shot of antibiotics in addition to oral antibiotics. Severe PID is treated in the hospital with IV antibiotics. Routine treatment of sex partners.

Public Lice / “Crabs”

“Crabs” There are 3 kinds of lice that can live on humans: head lice, body lice, and pubic or crab lice. Lice move relatively slowly and cannot survive more than 24 hrs. without human contact.

  • WTW Transmission: Absolutely! Any close contact w/ an infected person or their clothes or bed linens can allow for contact, so sex partners are at very high risk. However, you might be relieved to know that lice cannot hop or fly.
  • Symptoms: Itching, finding nits or lice.
  • Treatment: Special shampoos, cream rinses & lotions (obtained by prescription). All partners for the last 30 days must be treated. For washable clothing and bedding use HOT cycle of washer and dryer. Dry cleaning or keeping items isolated from body for 10 days will also kill lice and eggs.


A skin infestation by mites (tiny bugs). Mites likes to burrow in warm moist places like between fingers/toes, the wrist, armpits, breasts, skin folds, and waist. The female mite gives off a chemical as it burrows under the skin. This chemical, not bites, is what causes the itching.

  • Symptoms: Itching, especially at night. The first time a person gets scabies it takes 2-6 weeks for the itching to start. The second time a person gets scabies the itching starts in 1-2 days. Scabies can mimic other skin rashes and look differently on different people. Test for scabies is a small skin scraping for microscopic examination.
  • WTW Transmission: Yes. Primarily by close contact, including sex, with an infected person. Mites can live a couple of days in fabric and dust. An infected person can transmit scabies even if they have no symptoms.
  • Treatment: 5% permethrin cream (not the 1% used for lice). Be sure to put some lotion under finger and toe nails. All sex partners, close contacts, and anyone else living with you within the last month should be tested and treated. You may have to be treated more than once. Itching may continue for a few days even if the mites are dead, though it should lessen. For washable clothing, bedding, towels, rugs and toys use the HOT cycle of washer & dryer or dry clean. Things that can’t be washed in hot water can be placed in plastic bags and sealed for 3-4 weeks.


An STD caused by a spirochete that is usually detected with a blood test. Some of its most devastating effects occur when it is transmitted from a pregnant woman to her fetus.

  • Transmission WTW: unknown, but theoretically possible. Contact with the sores or rash of an infected person during sex is the main mode of transmission.
  • Symptoms: 10-90 days after sex a painless single sore appears in the area where contact was made. The sore “chancre” usually feels hard at the edges. It does not hurt. It can look like herpes, warts, scabies or hemorrhoids. The sore is very contagious. After 2-6 weeks the chancre goes away. If untreated, 6-8 weeks later, the second stage begins in about 30% of persons. Symptoms can last from 2 weeks to 6 months and include swollen lymph nodes, rashes, or a flu-like feeling. There may be different genital sores that look like flat grayish warts. Like other syphilis sores, these are highly infectious and can spread the disease. Symptoms start to go away in 2 weeks. Infection untreated beyond this point can eventually cause serious damage to the heart, nervous system, kidneys, eyes, and brain.
  • Treatment: Penicillin injection, routine treatment of sex partners.

“Trich”, a tiny protozoa, can present like BV but in contrast is definitely an STD. It lives in the moist areas of the genitals of infected people (e.g. vaginal fluid, genital glands).

  • Symptoms: Often causes foamy discharge with foul odor, but symptoms may be absent. Painful urination, itching or irritation are sometimes present. If symptoms occur, they usually occur 4-20 days after infection but can begin much later.
  • Transmission WTW: clearly documented, and probably underestimated. Partners should absolutely be evaluated and treated. Both partners should abstain from sexual activity until treated.
  • Treatment: metronidazole in a single dose. Partners should be treated.

Yeast Infection

This infection, also known as candidiasis, is caused by a yeast overgrowth which disrupts normal vaginal flora. Certain yeast (candida) normally live in the vagina in relatively low numbers without causing a problem.

  • Symptoms: burning &/or itching of the vulva, vagina; thick white discharge with cottage cheese appearance; possible yeasty odor.
  • Transmission WTW: unknown, but not considered an STD in heterosexual couples.
  • Treatment: anti-fungal creams, suppositories, or oral anti-fungals (tablets).
  • Note: While recurrent or difficult-to-treat yeast vaginitis usually occurs in completely healthy women, occasionally it may be indicative of diabetes (undiagnosed or uncontrolled), HIV infection, or genital herpes, and should be fully evaluated — consult your healthcare provider.

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