Gender diversity among sexual health clinic attendees increased significantly over 8 years, with nonbinary/genderqueer visits increasing from 0.7% to 3.5%, and NB/GQ patients had significantly lower odds of urogenital gonorrhea compared with men who have sex with men.
Key Findings
Results
The proportion of clinic visits among nonbinary/genderqueer (NB/GQ) and transgender patients increased significantly from 2016 to 2023.
NB/GQ visits increased from 0.7% to 3.5% of total visits (p trend <0.001)
Transgender visits increased from 0.7% to 1.7% of total visits (p trend <0.001)
Total dataset included 82,384 visits over January 2016 to October 2023 at Public Health Seattle & King County Sexual Health Clinic
Of all visits, 1,672 (2.0%) were NB/GQ, 867 (1.1%) were transgender, and 79,845 (96.9%) were cisgender
Results
NB/GQ identity was significantly associated with sex assigned at birth, age, and race.
NB/GQ identity was more common among patients assigned female versus male sex at birth (3.2% vs 1.8%, P < 0.001)
NB/GQ identity was more common among younger patients: 3.1% among ages 14-25 versus 0.2% among those over 46 (P < 0.001)
NB/GQ identity was more common among white versus Black patients (2.3% vs 1.0%, P < 0.001)
Chi-square tests were used to identify sociodemographic characteristics associated with cisgender, transgender, and NB/GQ identity
Results
NB/GQ patients had significantly lower odds of urogenital gonorrhea compared with men who have sex with men (MSM).
Adjusted odds ratio for urogenital gonorrhea among NB/GQ versus MSM: aOR 0.50 (95% CI, 0.32–0.80)
The difference in rectal chlamydia between NB/GQ and MSM was not statistically significant (aOR 0.78; 95% CI, 0.59–1.02)
The difference in syphilis between NB/GQ and MSM was not statistically significant (aOR 0.96; 95% CI, 0.87–1.06)
Associations were evaluated using generalized estimating equations
Results
There were no statistically significant differences in STI diagnoses or drug use outcomes between NB/GQ and transgender patients.
No significant differences were found between NB/GQ and transgender visits for any of the measured outcomes
Outcomes evaluated included syphilis, urogenital gonorrhea, rectal chlamydia, methamphetamine use, and nonprescribed injection drug use
Generalized estimating equations were used to evaluate these associations
Methods
The study used an 8-year dataset from an urban sexual health clinic to characterize trends and STI outcomes among gender-diverse populations.
Data were drawn from PHSKC Seattle Sexual Health Clinic visit records from January 2016 through October 2023
The Cochran-Armitage trend test was used to identify trends in reported gender identity over time
Chi-square tests were used to identify sociodemographic characteristics associated with gender identity categories
Outcomes of interest included syphilis, urogenital gonorrhea, rectal chlamydia, methamphetamine use, and nonprescribed injection drug use
What This Means
This research suggests that the number of people identifying as nonbinary or genderqueer (NB/GQ) who visit a large urban sexual health clinic in Seattle increased substantially between 2016 and 2023, rising from less than 1% to about 3.5% of all clinic visits. NB/GQ identity was more commonly reported among younger patients, those assigned female at birth, and white patients. These findings reflect broader societal trends in gender identity reporting and highlight the growing importance of inclusive data collection in sexual health settings.
When comparing STI diagnoses, NB/GQ patients were about half as likely to be diagnosed with urogenital gonorrhea compared to men who have sex with men (MSM), while rates of rectal chlamydia and syphilis were not significantly different between the two groups. There were also no significant differences in STI diagnoses or drug use outcomes between NB/GQ and transgender patients, suggesting these two groups may have similar sexual health profiles in this clinical context.
This research suggests that gender-diverse individuals represent a growing and distinct segment of sexual health clinic attendees with their own demographic and health patterns. The authors emphasize that continued monitoring of gender identity trends is essential for designing targeted STI and HIV prevention strategies that meet the specific needs of NB/GQ and transgender populations.
Lang J, Cannon C, Manhart L, Berzkalns A, Kerani R. (2026). Dynamics of Gender Identity With STI Diagnoses and Behavioral Outcomes Among Seattle Sexual Health Clinic Attendees, 2016-2023.. Sexually transmitted diseases. https://doi.org/10.1097/OLQ.0000000000002271