High rates of reinfection and incidence of bacterial sexually transmitted infections in a cohort of female sex workers from two Indian cities: need for different STI control strategies?
- Anjana Das1,
- Anupam Khungar Pathni2,
- Prakash Narayanan1,
- Bitra George3,
- Guy Morineau4,
- Tobi Saidel2,
- Parimi Prabhakar1,
- Gururaj Rao Deshpande5,
- Raman Gangakhedkar5,
- Sanjay Mehendale6,
- Arun Risbud5
- 1STI Capacity Raising, FHI 360, New Delhi, India
- 2Independent Consultant, New Delhi, India
- 3India Country Office, FHI 360, New Delhi, India
- 4Asia Pacific Regional Office, FHI 360, Bangkok, Thailand
- 5Department of Microbiology, National AIDS Research Institute, Pune, Maharashtra, India
- 6National Institute of Epidemiology, Chennai, Tamil Nadu, India
- Correspondence to Anjana Das, STI Capacity Raising, FHI 360, H-5 Ground Floor, Green Park Extension, New Delhi 110016, India;
- Received 6 January 2012
- Revised 12 October 2012
- Accepted 28 October 2012
- Published Online First 29 November 2012
Background Female sex workers (FSWs) in India are provided a standardised package of clinical interventions for management of sexually transmitted infections (STIs). A study was conducted among FSWs at known high STI prevalence sites to determine the effectiveness of the service package.
Methods A cohort of FSW clinic attendees in two cities, Hyderabad and Mumbai, were enrolled and followed up from October 2008 to November 2009. At each visit, behavioural and clinical data were obtained and vaginal swabs collected for laboratory testing of cervical infections (gonorrhoea and chlamydia).
Results 417 participants were enrolled, of whom 360 attended at least a follow-up visit. Prevalence of cervical infections did not change between the baseline and final visits (27.7% and 21.3% respectively, p=0.08) in spite of presumptive treatment at baseline and syndromic management at all visits. The proportion of asymptomatic cervical infections increased from 36% at baseline to 77% at the final visit. Incidence rate of cervical infections was high (85.6/100 person years) and associated with a prevalent cervical infection at baseline (HR=2.7, p<0.001) and inconsistent condom use with non-commercial partners (HR=2.5, p=0.014).
Conclusions High rates of STIs persisted despite the interventions due to poor condom use, minimal partner treatment, and high prevalence and incidence of STIs with a large proportion of asymptomatic infections. High-prevalence FSW sites in India need to design more effective partner treatment strategies and consider increasing the frequency of presumptive treatment as a temporary measure for quickly reducing STI prevalence, with renewed emphasis on consistent condom use with all partners.
This is an open-access article distributed under the terms of the Creative Commons Attribution Non-commercial License, which permits use, distribution, and reproduction in any medium, provided the original work is properly cited, the use is non commercial and is otherwise in compliance with the license. See: http://creativecommons.org/licenses/by-nc/3.0/ and http://creativecommons.org/licenses/by-nc/3.0/legalcode