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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
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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:

Sexual Health 7(1) 71-76
Submitted: 27 August 2009  Accepted: 24 November 2009   Published: 15 February 2010


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.


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.


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