Evidence‐based treatment guidelines for sexually transmitted infections developed with and for female sex workers

Abstract

Summarybackground Sex work is frequently one of the few options women in low-income countries have to generate income for themselves and their families. Treating and preventing sexually transmitted infections (STIs) among sex workers (SWs) is critical to protect the health of the women and their communities; it is also a cost-effective way to slow the spread of HIV. Outside occasional research settings however, SWs in low-income countries rarely have access to effective STI diagnosis.objectives To develop adequate, affordable, and acceptable STI control strategies for SWs. methods In collaboration with SWs we evaluated STIs and associated demographic, behavioural, and clinical characteristics in SWs living in two cities in Madagascar. Two months post-treatment and counselling, incident STIs and associated factors were determined. Evidence-based STI management guidelines were developed with SW representatives.results At baseline, two of 986 SWs were HIV(+); 77.5% of the SWs in Antananarivo and 73.5% in Tamatave had at least one curable STI. Two months post-treatment, 64.9% of 458 SWs in Antananarivo and 57.4% of 481 women in Tamatave had at least one STI. The selected guidelines include speculum exams; syphilis treatment based on serologic screening; presumptive treatment for gonorrhoea, chlamydia, and trichomoniasis during initial visits, and individual risk-based treatment during 3-monthly follow-up visits. SWs were enthusiastic, productive partners.conclusions A major HIV epidemic can still be averted in Madagascar but effective STI control is needed nationwide. SWs and health professionals valued the participatory research and decision-making process. Similar approaches should be pursued in other resource-poor settings where sex work and STIs are common and appropriate STI diagnostics lacking.

Socio-Demographic Characteristics and Behavioral Risk Factors of Female Sex Workers in Sub-Saharan Africa: A Systematic Review

“…In some settings, 10% or more have an active genital ulcer and over 30% have reactive syphilis serology [88,92,95,117,118]. Gonorrhea and Chlamydia infection may be found in a third or more of sex workers, trichomoniasis is common, and many women have multiple infections [23,42,78].…”

Sexually Transmitted Infection Control with Sex Workers: Regular Screening and Presumptive Treatment Augment Efforts to Reduce Risk and Vulnerability

“…Algorithms included speculum exams; syphilis treatment based on serologic screening; presumptive treatment for gonorrhoea, chlamydia, and trichomoniasis during initial visits, and individual risk-based treatment at three-month follow-up visits. 21 No follow-up information has been reported.…”

“…71 Sex workers themselves participated in algorithm development and intervention design in South Africa and Madagascar. 69,72 Strong coordination between clinical services and peer networks that promote prevention and encourage women to use services have been reported to be important programme elements associated with increased condom use and strong clinic attendance. 30,46 Provision of related health and social services valued by sex workers helps to improve programme credibility and strengthens prevention efforts.…”

Frequency of Serological Markers of <i>Chlamydia trachomatis</i> in Cases of Ectopic Pregnancy in Antananarivo Madagascar

“…In Madagascar, few studies have been reported on the frequency of Chlamydia trachomatis infection, the majority of studies have been carried out among sex workers with a rate of 12% to 17% in the province of Antananarivo [4 ] [5]. The present study is the first in estimating the prevalence of Chlamydia trachomatis in women with ruptured ectopic pregnancy.…”