Introduction Female sex workers (FSW) may experience barriers to accessing sexual health services. Appropriate treatment for STIs is paramount to prevent the spread of antibiotic resistant infections. We aimed to understand how healthcare access might impact self-treatment and antibiotic use for genitourinary symptoms among FSWs in Tijuana, Mexico.
Methods 282 FSW participants were tested for STIs and underwent an interview. APTIMA COMBO 2 (Hologic, Inc.) was used to diagnose cervicovaginal Neisseria gonorrhoeae (NG) infection. We summarised data and used logistic regression to assess associations between self-medication (use of pills and/or injections that were not prescribed by a doctor or nurse) for genitourinary symptoms and prior HIV test (a proxy for accessing sexual health services), income and STI history. Genitourinary symptoms included dysuria, vaginal discharge, vaginal bleeding between periods, pelvic pain, or dyspareunia.
Results 282 FSW participants were recruited in Tijuana. Of the 263 with test results, 41 (15.6%) tested positive for NG, of which 23 (56.1%) endorsed current genitourinary symptoms. Of the 282 total participants, 60 (21.3%) reported that they had ever self-medicated to treat genitourinary symptoms. Never having an HIV test (OR=2.3 (95% CI: 1.3, 4.3)) and reporting lower income (<MX$3500 vs. ≥MX$3500) (OR=2.2 (95% CI: 1.1, 3.6) were associated with reporting ever self-medicating for treatment of genitourinary symptoms. In addition, those that reported they had ever had an STI (n=83 (29.4%), OR=2.7 (95% CI: 1.5, 4.8)) were more likely to report self-medication for treatment of genitourinary symptoms.
Conclusion We found a high prevalence of NG infection among a cohort of FSWs in Tijuana, Mexico. The high prevalence and past medication use without a prescription point to a potential for emerging NG antibiotic resistance in this setting. Barriers to access for sexual healthcare may drive the use of medications without a prescription. Additionally, those with a history of STIs may be self-treating for familiar symptoms.