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 Das, Anupam Khungar Pathni, Prakash Narayanan, Bitra George, Guy Morineau, Tobi Saidel, Parimi Prabhakar, Gururaj Rao Deshpande, Raman Gangakhedkar, Sanjay Mehendale, Arun Risbud

Research output: Contribution to journalArticle

13 Citations (Scopus)

Abstract

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 noncommercial 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. Highprevalence 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.

Original languageEnglish
Pages (from-to)5-10
Number of pages6
JournalSexually Transmitted Infections
Volume89
Issue number1
DOIs
Publication statusPublished - 01-02-2013

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Sex Workers
Infection Control
Sexually Transmitted Diseases
Condoms
Incidence
Asymptomatic Infections
India
Infection
Chlamydia Infections
Gonorrhea
Therapeutics

All Science Journal Classification (ASJC) codes

  • Dermatology
  • Infectious Diseases

Cite this

Das, Anjana ; Pathni, Anupam Khungar ; Narayanan, Prakash ; George, Bitra ; Morineau, Guy ; Saidel, Tobi ; Prabhakar, Parimi ; Deshpande, Gururaj Rao ; Gangakhedkar, Raman ; Mehendale, Sanjay ; Risbud, Arun. / 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?. In: Sexually Transmitted Infections. 2013 ; Vol. 89, No. 1. pp. 5-10.
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title = "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?",
abstract = "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 noncommercial 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. Highprevalence 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.",
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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? / Das, Anjana; Pathni, Anupam Khungar; Narayanan, Prakash; George, Bitra; Morineau, Guy; Saidel, Tobi; Prabhakar, Parimi; Deshpande, Gururaj Rao; Gangakhedkar, Raman; Mehendale, Sanjay; Risbud, Arun.

In: Sexually Transmitted Infections, Vol. 89, No. 1, 01.02.2013, p. 5-10.

Research output: Contribution to journalArticle

TY - JOUR

T1 - High rates of reinfection and incidence of bacterial sexually transmitted infections in a cohort of female sex workers from two Indian cities

T2 - Need for different STI control strategies?

AU - Das, Anjana

AU - Pathni, Anupam Khungar

AU - Narayanan, Prakash

AU - George, Bitra

AU - Morineau, Guy

AU - Saidel, Tobi

AU - Prabhakar, Parimi

AU - Deshpande, Gururaj Rao

AU - Gangakhedkar, Raman

AU - Mehendale, Sanjay

AU - Risbud, Arun

PY - 2013/2/1

Y1 - 2013/2/1

N2 - 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 noncommercial 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. Highprevalence 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.

AB - 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 noncommercial 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. Highprevalence 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.

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