Llangarí-Arizo, LM; Broad, CE; Zhou, L; Martin Mateo, M; Moreno, CI; Moreno Cevallos, M; Cooper, PJ; Romero-Sandoval, N; Sadiq, ST
(2024)
Sexually transmitted infections among at-risk women in Ecuador: implications for global prevalence and testing practices for STIs detected only at the anorectum in female sex workers.
Sexually Transmitted Infections.
ISSN 1368-4973
https://doi.org/10.1136/sextrans-2023-056075
SGUL Authors: Sadiq, Syed Tariq
Abstract
Objectives Anorectal sexually transmitted infections (STIs) such as Chlamydia trachomatis (CT) and Neisseria gonorrhoeae (NG), present treatment challenges, potentially increase antibiotic resistance selection and if undetected may facilitate onward transmission. However, there are limited global prevalence data for anorectal STIs. We conducted a cross-sectional study to assess the prevalence and risk factors of non-viral genital and extragenital STIs in female sex workers (FSW) and female non-sex workers (NSW) in Ecuador.
Methods 250 adult street and brothel FSWs and 250 NSWs, recruited from settlements in north-west Ecuador provided oropharyngeal and vulvo-vaginal swabs (VVS) as well as socio-demographic data. FSWs also provided anorectal swabs. PCR was used to detect CT, NG, Mycoplasma genitalium (MG) from all swabs and additionally Trichomonas vaginalis (TV) from VVS. Risk factors were analysed using logistic regression.
Results Prevalence of FSW vaginal, anorectal and oropharyngeal infection was 32.0% (95% CI 26.5% to 38.0%), 19.7% (95% CI 15.1% to 25.2%) and 3.2% (95% CI 1.6% to 6.2%), respectively, with most vaginal infections being TV (23.4%; 95% CI 18.5% to 29.2%). Overall FSW STI prevalence, at any anatomical site was 39.7% (95% CI 33.8% to 46.1%), with 12.1% (95% CI 8.5% to 16.9%) of infections detected only at the anorectum. Of all the CT and/or NG infections, 64.4% (95% CI 50.4% to 78.4%) were detected only at the anorectum. STI prevalence in NSWs in the vagina and oropharynx were 5.6% (95% CI 3.4% to 9.2%) and 0.8% (95% CI 0.2% to 2.9%), respectively, with most vaginal infections being MG (3.2%; 95% CI 1.6% to 6.2%). In multivariable analysis, risk factors among brothel-based FSWs for having an anorectal STI were vaginal CT, NG or MG (p<0.001), vaginal TV (p=0.029) and being ‘in a relationship’ (p=0.038).
Conclusions High prevalence of CT and NG detected only at the anorectum in these FSWs indicate the possibility of missing significant infections if providing only genital testing and calls for greater research into the potential impact on global STI estimates if extragenital infections among at-risk women are not identified.
Item Type: |
Article
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Additional Information: |
© Author(s) (or their employer(s)) 2024. Re-use permitted under CC BY. Published by BMJ. https://creativecommons.org/licenses/by/4.0/
This is an open access article distributed in accordance with the Creative Commons Attribution 4.0 Unported (CC BY 4.0) license, which permits others to copy, redistribute, remix, transform and build upon this work for any purpose, provided the original work is properly cited, a link to the licence is given, and indication of whether changes were made. See: https://creativecommons.org/licenses/by/4.0/. |
Keywords: |
1103 Clinical Sciences, 1108 Medical Microbiology, 1117 Public Health and Health Services, Public Health |
SGUL Research Institute / Research Centre: |
Academic Structure > Infection and Immunity Research Institute (INII) Academic Structure > REF 2021 user group |
Journal or Publication Title: |
Sexually Transmitted Infections |
ISSN: |
1368-4973 |
Language: |
en |
Dates: |
Date | Event |
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7 August 2024 | Published Online | 26 June 2024 | Accepted |
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Publisher License: |
Creative Commons: Attribution 4.0 |
Projects: |
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URI: |
https://openaccess.sgul.ac.uk/id/eprint/116735 |
Publisher's version: |
https://doi.org/10.1136/sextrans-2023-056075 |
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