Sexually Transmitted Infection Testing and Prevalence Among Veterans With and Without Military Sexual Trauma.

Background: Since the Veterans Health Administration (VHA) implemented universal screening for military sexual trauma (MST) in 2001, one-third of female Veterans and 1 in 50 male Veterans have reported MST. Despite evidence that MST negatively impacts physical and mental health and has been associated with sexual practices that increase the risk of acquiring sexually transmitted infections (STIs), little is known about the association between MST and STI risk in Veterans.

Objective: To assess the percent tested for an STI, STI prevalence, and odds of acquiring an STI among Veterans in VHA care during 2022 with and without a history of MST.

Design: Retrospective cohort study of Veterans in VHA care during 2022 who ever completed VHA's MST screening questions. Metrics of STI testing and infection were obtained for 2022.

Participants: All Veterans in VHA care during 2022, defined as at least one inpatient or outpatient visit in 2022 or the previous year, who completed VHA's MST screening questions.

Key results: Of nearly 6.4 million Veterans in VHA care during 2022 who ever answered the MST screening questions, 35% of female and 2% of male Veterans reported a history of MST. Male Veterans with MST had an increased STI prevalence compared to those without MST (0.7% vs. 0.2%); no difference was observed in STI prevalence among female Veterans with and without MST (0.3% vs. 0.2%). Among male Veterans tested for an STI, MST was associated with a 23% increased odds of acquiring an STI after adjusting for key demographic and health-related factors.

Conclusions: In male Veterans tested for an STI, MST was associated with an increased risk of STI acquisition, a finding not seen in female Veterans. Differences in health care utilization, sexual behaviors, and mental health sequelae from sexual trauma between males and females may explain this finding.