Self-reported bacterial STI testing and diagnoses among a nationwide online sample of United States transgender women, 2022-2023

Estimates of sexually transmitted infection (STI) testing and diagnoses among U.S. transgender women are limited despite being important to prevention and treatment efforts. To evaluate self-reported bacterial STI testing and diagnoses in the past 12 months among sexually active transgender women, we surveyed a nationwide online sample of transgender women ≥15 years in 2022-2023. We calculated unadjusted prevalence ratios (PR) and 95% confidence intervals (95% CI) using log-binomial regression. Among 3,057 transgender women, 1,012 (33.1%) reported bacterial STI testing and of these, 159 (15.7%) reported ≥1 bacterial STI diagnosis. Testing was positively associated with condomless anal sex (PR = 1.49, 95% CI = 1.35-1.65), gender identity disclosure to a healthcare provider (PR = 2.25, 95% CI = 1.80-2.81), and current gender-affirming hormone therapy (PR = 1.61, 95% CI = 1.41-1.82) but negatively associated with younger age (PR = 0.72, 95% CI = 0.61-0.85) and severe depression (PR = 0.74, 95% CI = 0.57-0.96). STI diagnosis was greater among Black, non-Hispanic (PR = 2.28, 95% CI = 1.58-3.29) and Hispanic transgender women (PR = 1.55, 95% CI = 1.01-2.38) compared to White, non-Hispanic. Condomless anal sex (PR = 1.52, 95% CI = 1.13-2.04), problem drinking (PR = 1.20, 95% CI = 1.20-2.27), and HIV (PR = 4.51, 95% CI = 3.34-6.09) were positively associated with STI diagnosis. Current gender-affirming hormone therapy (PR = 0.51, 95% CI = 0.39-0.69) was negatively associated with STI diagnosis. Bacterial STI testing was low, but diagnoses was high in this sample of transgender women. Differences in testing and diagnoses were associated with socio-demographic and behavioral factors. STI interventions tailored to transgender women are needed to increase testing and detection, prevent transmission, and reduce racial/ethnic disparities.