Syndromic Versus Laboratory-Based Diagnosis of Cervical Infections Among Female Sex Workers in Benin

Mukenge-Tshibaka, Léonard; Alary, Michel; Lowndes, Catherine M; Dyck, E Van; Guédou, A.; Geraldo, Nassirou; Anagonou, S.; Lafia, E.; Joly, J

doi:10.1097/00007435-200206000-00003

Cited by 43 publications

(26 citation statements)

References 18 publications

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“…34 In addition, the fact that the LED test is rapid and inexpensive and can be administered at the point of care makes it a particularly useful test in a context where high rates of non-attendance for return visits occur, as shown for example in FSWs in Cotonou. 35 It has been shown that even in the industrialised world, non-attendance for follow up visits can have a negative impact on STI treatment rates. 36 In our study, the LED test had perfect performance parameters in symptomatic men.…”

Section: Discussionmentioning

confidence: 99%

Sexually transmitted infections in male clients of female sex workers in Benin: risk factors and reassessment of the leucocyte esterase dipstick for screening of urethral infections

Alary

Lowndes²,

Mukenge-Tshibaka³

et al. 2003

Sexually Transmitted Infections

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Objectives: (1) To assess risk factors for urethral infections with Chlamydia trachomatis, Neisseria gonorrhoeae, and Trichomonas vaginalis among male clients of female sex workers (FSWs) in Benin; (2) to study the validity of LED testing of male urine samples compared to a highly sensitive gold standard (PCR) for the diagnosis of urethral infections with the organisms cited above. Methods: Male clients of FSWs (n = 404) were recruited on site at prostitution venues in Cotonou, Benin, between 28 May and 18 August 1998. A urine sample was obtained from each participant just before he visited the FSW, and tested immediately using a leucocyte esterase dipstick (LED) test. It was then tested for HIV using the Calypte EIA with western blot confirmation, and for C trachomatis, N gonorrhoeae, and T vaginalis by PCR. After leaving the FSW's room, participants were interviewed about demographics, sexual behaviour, STI history and current symptoms and signs, and were examined for urethral discharge, genital ulcers, and inguinal lymphadenopathies. Results: STI prevalences were: C trachomatis, 2.7%; N gonorrhoeae, 5.4%; either chlamydia or gonorrhoea 7.7%; T vaginalis 2.7%; HIV, 8.4%. Lack of condom use with FSWs and a history of STI were independently associated with C trachomatis and/or N gonorrhoeae infection. Over 80% of these infections were in asymptomatic subjects. The overall sensitivity, specificity, positive and negative predictive values of the LED test for detection of either C trachomatis or N gonorrhoeae were 48.4%, 94.9%, 44.1%, and 95.7%, respectively. In symptomatic participants (n = 22), all these parameters were 100% while they were 47.4%, 94.7%, 37.5%, and 96.4% in asymptomatic men (n = 304). Conclusions: Since most STIs are asymptomatic in this population, case finding programmes for gonorrhoea and chlamydia could be useful. The performance characteristics of the LED test in this study suggest that it could be useful to detect asymptomatic infection by either C trachomatis or N gonorrhoeae in high risk men.

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Section: Discussionmentioning

confidence: 99%

Sexually transmitted infections in male clients of female sex workers in Benin: risk factors and reassessment of the leucocyte esterase dipstick for screening of urethral infections

Alary

Lowndes²,

Mukenge-Tshibaka³

et al. 2003

Sexually Transmitted Infections

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“…Finally, the relatively high loss-to-follow-up in studies among sex workers is perhaps another indication of the transient nature of this population [88][89][90][91]. Overall, large shifts in sex worker populations and settings, which complicate service provision, demonstrate the potential for localized HIV epidemics to spread along transport routes and to adjacent communities.…”

Section: Sex Work and Population Mobilitymentioning

confidence: 99%

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

et al. 2011

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Sex work remains an important contributor to HIV transmission within early, advanced and regressing epidemics in sub-Saharan Africa, but its social and behavioral underpinnings remain poorly understood, limiting the impact of HIV prevention initiatives. This article systematically reviews the socio-demographics of female sex workers (FSW) in this region, their occupational contexts and key behavioral risk factors for HIV. In total 128 relevant articles were reviewed following a search of Medline, Web of Science and Anthropological Index. FSW commonly have limited economic options, many dependents, marital disruption, and low education. Their vulnerability to HIV, heightened among young women, is inextricably linked to the occupational contexts of their work, characterized most commonly by poverty, endemic violence, criminalization, high mobility and hazardous alcohol use. These, in turn, predict behaviors such as low condom use, anal sex and co-infection with other sexually transmitted infections. Sex work in Africa cannot be viewed in isolation from other HIV-risk behaviors such as multiple concurrent partnerships-there is often much overlap between sexual networks. High turn-over of FSW, with sex work duration typically around 3 years, further heightens risk of HIV acquisition and transmission. Targeted services at sufficiently high coverage, taking into account the behavioral and social vulnerabilities described here, are urgently required to address the disproportionate burden of HIV carried by FSW on the continent.

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“…Epidemiologic surveillance has consistently confirmed the role of commercial sex in driving heterosexual HIV transmission, especially in early epidemics. (22): [74][75][76][77][78][79][80][81][82][83][84][85][86][87][88][89][90] Clients and other partners of sex workers also have high rates of STIs and HIV, 40 and serve as both a constant source of re-infection for sex workers and as a transmission bridge to the general population. Effective STI control among sex workers and their clients and partners would thus be beneficial for sex workers as well as have potentially large public health benefits for the general population.…”

mentioning

confidence: 99%

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

Steen

Dallabetta

2003

Reproductive Health Matters

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Syndromic Versus Laboratory-Based Diagnosis of Cervical Infections Among Female Sex Workers in Benin

Abstract: The syndromic diagnosis approach should continue to be used for female sex workers in Benin because returning for treatment is problematic. Presumptive treatment at their initial visit could be a complement to this approach, given the high prevalence of cervicitis in this population.

Cited by 43 publications

References 18 publications

Sexually transmitted infections in male clients of female sex workers in Benin: risk factors and reassessment of the leucocyte esterase dipstick for screening of urethral infections

Sexually transmitted infections in male clients of female sex workers in Benin: risk factors and reassessment of the leucocyte esterase dipstick for screening of urethral infections

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

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

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