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RESEARCH ARTICLE

A cross-sectional study of reported symptoms for sexually transmissible infections among female sex workers in Papua New Guinea

Eunice Bruce A G , Ludwina Bauai B , Andrew Masta C , Poyap J. Rooney C , Michael Paniu C , Mathias Sapuri D , Louise Keogh E , John Kaldor F and Christopher K. Fairley A
+ Author Affiliations
- Author Affiliations

A Melbourne Sexual Health Centre, School of Population Health, The University of Melbourne, Vic. 3053, Australia.

B Pacific Adventist University, Port Moresby, Papua New Guinea.

C School of Medicine and Health Sciences, University of Papua New Guinea, NDC, Papua New Guinea.

D Pacific International Hospital, 4 Mile PO Box, 6103 Stores Road, Boroko, Port Moresby, National Capital District, Papua New Guinea.

E Key Centre for Women’s, Health in Society, Department of Public Health, The University of Melbourne, Vic. 3053, Australia.

F National Centre in HIV Epidemiology and Clinical Research, University of New South Wales, Sydney, NSW 2052, Australia.

G Corresponding author. Email: ebruce@mshc.org.au

Sexual Health 7(1) 71-76 https://doi.org/10.1071/SH09093
Submitted: 27 August 2009  Accepted: 24 November 2009   Published: 15 February 2010

Abstract

Background: Sexually transmissible infections (STIs) are common in female sex workers (FSWs), most of which are asymptomatic and therefore under-reported. Our aim was to determine the sensitivity and specificity of reported symptoms obtained via questionnaire augmented with leukocyte esterase (LE) urine dipstick test for the detection of Chlamydia trachomatis (Ct), Neisseria gonorrhea (Ng) and Trichomonas vaginalis (Tv) detected using polymerase chain reaction (PCR). Methods: In November 2003, a cohort of FSWs was screened for STIs and completed a questionnaire. Results: We enrolled 129 FSWs (90% participation rate) of whom 48 (37%), 30 (23%) and 53 (41%) were diagnosed with Ng, Ct and Tv, respectively, by PCR. Of those diagnosed with any of these infections, 78% reported anogenital symptoms and of those without infections, 28% reported symptoms. Anogenital symptoms were present in over 50% FSWs. Genital odour (present in 26%), lower abdominal pain (present in 29%), dysuria (present in 19%) had a sensitivity around (50%), specificity (>80%) and all were significantly associated with positive PCR results for individual organisms; however, the sensitivity of these symptoms to detect the presence of any positive PCR result was low (<50%). When LE urine dipstick test result of >1 was combined with the presence of three reported symptoms the sensitivity was 86%, specificity of 73% and a positive predictive value of 72%; a better predictor of infections. Conclusions: Our finding suggest an approach that incorporates LE urine dipstick test >1 and multiple symptoms may be a feasible option for screening infections among FSWs in resource constraint settings.

Additional keywords: anogenital symptoms, leukocyte esterase urine dipstick test, polymerase chain reaction, positive predictive value, screening, sensitivity, specificity.


Acknowledgements

This study was funded by UNFPA as part of the UNAIDS Regional UBW financial assistance scheme. The authors thank Mr Dual Owusu – Sarfo (UNFAP), Mrs. Miriam Midirie (UNFAP), Mr. Wilfred Peters (NACS), World Vision International staff, Medical/Laboratory staff – School of Medicine & Health Sciences, Port Moresby, National Department of Health – HIV/STI Branch, volunteers, health extension officers and the female sex workers for their assistance in the preparation and participation in the survey.


References


[1] Mgone CS,  Passey M,  Anang J,  Peter W,  Lupiwa T,  Russel BB, et al. Human immunodeficiency virus and other sexually transmitted infections among female sex workers in two major cities in Papua New Guinea. Sex Transm Dis 2002; 29 265–70.
CrossRef | PubMed |

[2] Gare J,  Lupiwa T,  Suarkia DL,  Paniu MM,  Wahasoka A,  Nivia H, et al. High prevalence of sexually transmitted infections among female sex workers in the eastern highlands province of Papua New Guinea: correlates and recommendations. Sex Transm Dis 2005; 32 466–73.
CrossRef | PubMed |

[3] Steen R,  Dallabetta G. Sexually transmitted infection control with sex workers: regular screening and presumptive treatment augment efforts to reduce risk and vulnerability. Reprod Health Matters 2003; 11 74–90.
CrossRef | PubMed |

[4] Wi T,  Ramos ER,  Steen R,  Esguerra TA,  Roces MCR,  Lim-Quizon MC, et al. STI declines among sex workers and clients following outreach, one time presumptive treatment, and regular screening of sex workers in the Philippines. Sex Transm Infect 2006; 82 386–91.
CrossRef | CAS | PubMed |

[5] WHO. Guidelines for the management of sexually transmitted infections. Geneva: World Health Organization; 2003. Available online at: http://www.who.int/hiv/pub/sti/en/STIGuidelines2003.pdf [verified November 2009].

[6] Behets FM,  Rasolofomanana JR,  Van-Damme K,  Vaovola G,  Andriamiadana J,  Ranaivo A, et al. Evidence-based treatment guidelines for sexually transmitted infections developed with and for female sex workers. Trop Med Int Health 2003; 8 251–8.
CrossRef | PubMed |

[7] Brabin L. Clinical management and prevention of sexually transmitted diseases – a review focusing on women. Acta Trop 2000; 75 53–70.
CrossRef | CAS | PubMed |

[8] Vuylsteke B,  Laga M,  Alary M,  Gerniers MM,  Lebughe JP,  Nzila N, et al. Clinical algorithms for the screening of women for gonococcal and chlamydial infection: evaluation of pregnant women and prostitutes in Zaire. Clin Infect Dis 1993; 17 82–8.
CAS | PubMed |

[9] Bruce EA , Bauai L , Keogh LA , Kaldor JM , Fairley CK . Geographical mapping and size estimation of the female sex worker population in the national capital district, Port Moresby, Papua New Guinea. Proceedings of the Australasian Sexual Health Conference ‘Diamonds and Pearls’; 2008 Sep 15–17; Perth, Western Australia. Sydney: The Royal Australasian College of Physicians; 2008.

[10] Thomas T,  Choudhari S,  Kariuki C. Identifying cervical infection among pregnant women in Nairobi, Kenya: limitations of risk assessment and symptom-based approaches. Gend Med 1996; 72 334–8.
CAS |

[11] Desai VK,  Kosambiya JK,  Thakor HG,  Umrigar DD,  Khandwala BR,  Bhuyan KK. Prevalence of sexually transmitted infections and performance of STI syndromes against aetiological diagnosis in female sex workers of red light area in Surat, India. Sex Transm Infect 2003; 79 111–5.
CrossRef | CAS | PubMed |

[12] Kosambiya JK,  Desai VK,  Thakor HS,  Umarigar DD,  Khandwala BR. Risk markers for presence of STIs in female commercial sex workers, India. Indian J Sex Transm Dis 2005; 26 26–32.


[13] Mulanga-Kabeya C,  Morel E,  Patrel D,  Delaporte E,  Bougoudogo F,  Maiga YI, et al. Prevalence and risk assessment for sexually transmitted infections in pregnant women and female sex workers in Mali: is syndromic approach suitable for screening? Sex Transm Infect 1999; 75 358–9.
CrossRef | CAS | PubMed |

[14] Ward E,  Spruyt A,  Fox L,  Johnson L,  Wong E,  Behets F, et al. Strategies for detection of sexually transmitted infection among family planning clients in Jamaica. Int Fam Plan Perspect 2001; 27 201–7.
CrossRef |

[15] Obunge OK,  Brabin L,  Dollimore N,  Kemp J,  Ikokwu-Wonodi C,  Babatunde S, et al. A flowchart for managing sexually transmitted infections among Nigerian adolescent females. Bull World Health Organ 2001; 79 301–5.
CAS | PubMed |

[16] Kapiga SH,  Vuylsteke B,  Lyamuya EF,  Dellabetta G,  Laga M. Evaluation of sexually transmitted diseases diagnostic algorithms among family planning clients in Dar es Salaam, Tanzania. Sex Transm Infect 1998; 74(Suppl. 1): S132–8.
PubMed |

[17] Knud-Hansen CR,  Dallabetta GA,  Reichart C,  Pabst KM,  Hook EW,  Wasserheit JN. Surrogate methods to diagnose gonococcal and chlamydial cervicitis: comparison of leukocyte esterase dipstick, endocervical gram stain, and culture. Sex Transm Dis 1991; 18 211–6.
CAS | PubMed |

[18] Devillé WL,  Yzermans JC,  van Duijn NP,  Bezemer PD,  van der Windt DA,  Bouter LM. The urine dipstick test useful to rule out infections. A meta-analysis of the accuracy. BMC Urol 2004; 4 4.
CrossRef | PubMed |

[19] van Dam CJ,  Beckerj KM,  Ndowa F,  Islam MQ. Syndromic approach to STD case management: where do we go from here? Sex Transm Infect 1998; 74(Suppl. 1): S175–8.
CrossRef | PubMed |

[20] Sloan NL,  Winikoff B,  Harberland N,  Coggins C,  Elias C. Screening and syndromic approaches to identify gonorrhea and chlamydial infections among women. Stud Fam Plann 2000; 31 55–68.
CrossRef | CAS | PubMed |

[21] Bogaerts J,  Ahmed J,  Akhter N,  Begumn N,  van Ranst M,  Verhaegen J. Sexually transmitted infections in a basic health care clinic in Dhaka, Bangladesh – syndromic management for activities is not justified. Sex Transm Infect 1999; 75 437–8.
CrossRef | CAS | PubMed |

[22] Vishwanath S,  Talvar V,  Prasad R,  Coyaji K,  Elias CJ,  DeZoysa I. Syndromic management of vaginal discharge among women in a reproductive health clinic in India. Sex Transm Infect 2000; 76 303–6.
CrossRef | CAS | PubMed |



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