Preventive Sexual Health Screening Among Female-to-Male Transgender Adult Patients

Project Summary

Background: Female-to-male (FTM) transgender men are individuals born with female reproductive organs but who identify as male. The majority of FTM transgender men do not undergo complete sex reassignment surgery and therefore retain their female natal reproductive organs (e.g., cervix). Cervical cancer, human papillomavirus (HPV), and other sexually transmitted infections (STIs) lead to significant morbidity and mortality in the United States. However, basic clinical data are lacking on the prevalence of abnormal cervical cytology and biologically confirmed prevalence of HPV and other STIs in FTM transgender patients. Further, our team’s formative research suggests that 36 percent of FTM transgender patients are not up-to-date on screening.

Objectives: To assess acceptability and effectiveness of alternative preventive sexual-health screening technologies, including self-swab, for cervical cancer, HPV screening, and biologically confirmed STIs in FTM transgender patients.

Methods: We will conduct a cross-sectional, observational mixed-methods biobehavioral study of preventive sexual health screening with 100 sexually active FTM transgender patients recruited through Fenway Health in Boston, Massachusetts.

• Aim 1: Quantitatively and qualitatively assess the acceptability, feasibility, and effectiveness of vaginal self-swab for HPV DNA testing compared with provider cervical swab and Pap test (cervical cytology) among FTM transgender patients.
• Aim 2: Investigate the prevalence of other STIs among FTM transgender patients, concordance of self-swabs and provider swabs for STIs, and describe risk and protective factors for STI diagnosis.

Patient Outcomes:

Aim 1:

1. Concordance of vaginal self-swab and provider cervical swab for HPV DNA
2. Concordance of each HPV DNA swab with Pap test results (cervical cytology)
3. Acceptability of self-swab technologies for HPV DNA testing for cervical cancer screening

Aim 2:

1. Clinically confirmed prevalence of HIV, syphilis, gonorrhea, chlamydia, bacterial vaginosis, and trichomoniasis
2. Concordance of each self-swab with provider swab for STIs
3. Any biologically confirmed STI
4. Any self-reported lifetime STI

Patient and Stakeholder Engagement: This project was conceptualized by and for FTM transgender patients. Patients and stakeholders are key personnel. The team includes representatives from the National Center of Excellence for Transgender Health, the World Professional Association for Transgender Health, and the National Lesbian, Gay, Bisexual, and Transgender Health Education Center. Future engagement includes a project-specific task force, website, and focus groups.

Anticipated Impact: This project will have a national and international impact on sexual health screening for FTM transgender patients, a hard-to-reach and underserved patient group, at Fenway Health and beyond. The project will lead to potential alternative screening strategies, as well as less invasive STI detection practices, that may generalize to other at-risk natal female populations that are not being screened.