Introduction
Sexually transmitted infections (STIs) remain a public health concern across all populations, and much of the sexual health discourse has traditionally focused on heterosexual relationships or male same-sex relations. However, an often-overlooked demographic in sexual health education is women who have sex with women (WSW). One common misconception is that WSW are at little to no risk for STIs, particularly chlamydia. This assumption is not only inaccurate but also potentially harmful, as it can lead to reduced awareness, lower screening rates, and untreated infections.
What is Chlamydia?
Chlamydia is a common bacterial STI caused by the organism Chlamydia trachomatis. It affects both men and women and can infect several sites of the body, including the cervix, urethra, rectum, throat, and eyes. Chlamydia is known for its often silent nature—many people who contract the infection experience no symptoms, which contributes to its high prevalence and underdiagnosis.
Common Symptoms in Women
When symptoms do occur, they may include:
- Vaginal discharge
- Burning during urination
- Pain during intercourse
- Lower abdominal pain
- Bleeding between periods
- Rectal pain or discharge (if the rectum is infected)
Left untreated, chlamydia can lead to serious health complications, including pelvic inflammatory disease (PID), infertility, and increased susceptibility to HIV.
How is Chlamydia Transmitted?
Chlamydia spreads primarily through sexual contact with an infected person. This includes:
- Vaginal intercourse
- Anal sex
- Oral sex
- Genital-to-genital contact (without penetration)
- Sharing sex toys without proper cleaning
Although vaginal or anal intercourse is often emphasized in STI education, chlamydia can be transmitted through any exchange of genital fluids, mucous membrane contact, or contaminated objects, which is particularly relevant to WSW.
Misconceptions About WSW and STIs
There is a persistent myth that women who have sex only with other women are at negligible risk for STIs. This belief is perpetuated by societal taboos, gaps in sex education, and even some healthcare providers’ biases. In reality, numerous studies have documented STI transmission between WSW, including chlamydia.
One of the reasons this misconception persists is that public health messaging and research often focus on heterosexual or male same-sex populations. As a result, WSW may not receive the necessary information or screenings appropriate for their sexual practices.
Can Women Who Have Sex with Women Get Chlamydia?
Yes—WSW can and do get chlamydia. Transmission can occur in various ways, many of which are common in sexual activity between women. Here’s how:
1. Genital-to-Genital Contact
Direct vulva-to-vulva contact can transmit chlamydia if one partner is infected, especially if there are fluids involved. The chlamydia bacterium can travel via vaginal secretions or skin contact involving mucous membranes.
2. Use of Shared Sex Toys
Using dildos, vibrators, or other penetrative devices between partners without washing or using new condoms between uses can spread chlamydia. The bacteria can survive on these surfaces long enough to infect the next user.
3. Oral Sex
While the risk is lower than with vaginal or anal sex, chlamydia can be transmitted through oral-genital contact. Throat infections with Chlamydia trachomatis can occur and serve as a source of further transmission.
4. Digital-Vaginal or Digital-Anal Contact
Fingers can act as vectors for bacteria if they touch infected fluids or tissues and are then introduced to another person’s genitalia without being washed.
5. Cervical Mucous or Vaginal Discharge Contact
Chlamydia resides in the mucosal lining and secretions of the cervix and urethra. Contact with these fluids can facilitate transmission, regardless of the gender of one’s partner.
What Does the Research Say?
Several studies have confirmed that WSW can acquire and transmit chlamydia:
- A study published in Sexually Transmitted Infections found chlamydia infections in 5-19% of women who reported exclusive same-sex behavior, depending on the population studied.
- Research from the Centers for Disease Control and Prevention (CDC) indicates that WSW may still acquire STIs through contact with infected secretions or sex toys.
- A 2014 review in Journal of Clinical Medicine highlighted that STI transmission among WSW is underreported due to lower screening rates, not necessarily lower risk.
Why WSW May Be at Increased Risk for Undiagnosed Chlamydia
1. Under-Screening
Many WSW do not get regularly tested for chlamydia because they believe—or are told—that they are at low risk. Some healthcare providers may not recommend testing if a patient discloses exclusively female partners, leading to missed diagnoses.
2. Lack of Tailored Education
Most sex education materials do not address the specific risks and prevention methods relevant to WSW. This gap leaves many without the knowledge to protect themselves adequately.
3. Barriers to Healthcare Access
Discrimination, lack of culturally competent care, and fear of being judged can deter WSW from seeking regular sexual health services.
4. Assumptions in Clinical Settings
Some clinicians assume that STI risk is only relevant in the context of penis-in-vagina or penis-in-anus sex, leading to fewer sexual history questions and less testing.
Symptoms and Diagnosis in WSW
Recognizing Symptoms
Because chlamydia is frequently asymptomatic, especially in women, routine screening is the most reliable way to detect infection. When symptoms do appear, they are the same regardless of a person’s sexual orientation. Symptoms may involve:
- Abnormal vaginal discharge
- Pelvic pain
- Burning with urination
- Painful sex
- Irregular bleeding
Diagnostic Testing
- NAAT (Nucleic Acid Amplification Test): The most sensitive test for chlamydia, typically performed on a urine sample, vaginal swab, or cervical swab.
- Self-collected vaginal swabs have been shown to be as effective as clinician-collected samples, offering a comfortable option for many.
Treatment and Management
Chlamydia is easily treatable with antibiotics. The standard treatment involves:
- Doxycycline 100 mg twice a day for 7 days
(as of current guidelines, although azithromycin may still be used in some cases)
Sexual partners should also be treated to avoid reinfection, and individuals should abstain from sexual activity for 7 days after treatment is completed.
Prevention Strategies for WSW
Despite the unique aspects of WSW sexual activity, effective STI prevention is possible with the right precautions.
1. Use Barriers
- Dental dams can reduce the risk during oral-genital contact.
- Gloves can be used for digital penetration, particularly if there are cuts or abrasions.
- Condoms on sex toys should be changed between partners.
2. Avoid Sharing Sex Toys Without Cleaning
Sex toys should be:
- Washed thoroughly with soap and water after use
- Disinfected according to manufacturer’s instructions
- Used with condoms that are changed between partners
3. Regular STI Screening
Women, including WSW, should follow CDC guidelines and get tested for chlamydia annually if:
- They are under 25 and sexually active
- They have a new or multiple partners
- They have a partner with an STI
WSW with a history of sex with men should also be screened, as previous exposure may still present a risk.
4. Open Communication With Partners
Discussing STI history, testing routines, and protection methods can foster safer sexual practices and mutual accountability.
The Role of Healthcare Providers
Healthcare providers must play a critical role in addressing the sexual health of WSW by:
- Taking comprehensive, nonjudgmental sexual histories
- Offering inclusive sexual health education
- Recommending routine STI screening based on behavior, not assumptions about orientation
- Providing culturally competent and respectful care
Training and continuing education are essential to ensure that healthcare workers do not overlook or minimize the risks faced by WSW.
Conclusion
The answer to the question, “Can women who have sex with women get chlamydia?” is an unequivocal yes. WSW are not immune to STIs, including chlamydia, and they deserve access to accurate information, regular screening, and comprehensive sexual health care. Persistent myths, lack of representation in public health messaging, and systemic gaps in healthcare delivery continue to put WSW at risk—not because of their behavior, but because of society’s failure to adequately address it.
Breaking down these barriers begins with inclusive education, supportive healthcare environments, and proactive risk reduction. Whether through safer sex practices, open dialogue, or routine STI testing, WSW can take control of their sexual health—and the healthcare system must support them in doing so.