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ORIGINAL ARTICLE Table of Contents   
Year : 2009  |  Volume : 52  |  Issue : 2  |  Page : 198-199
Sexually transmitted infections and reproductive tract infections in female sex workers


1 Department of Microbiology, Government Medical College, Surat, Veer Narmad South Gujarat University, India
2 Department of Preventive and Social Medicine, Government Medical College, Surat, Veer Narmad South Gujarat University, India

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   Abstract 

The present study was conducted in 300 female sex workers (FSWs) from Surat city in 2005-2006. Vaginal swabs, endocervical swabs and serum samples were collected from each of these FSWs. Vaginal samples were screened for bacterial vaginosis (BV), candidiasis and Trichomonas vaginalis . Endocervical swabs were screened for gonococcal infection. Serological tests for human immunodeficiency virus (HIV), hepatitis B surface antigen (HBsAg) and syphilis were performed. From a total of 300 FSWs, BV was detected in 40 (13.33%), trichomoniasis in six (2%), candidiasis in 31 (10.33%), HIV seropositivity in 35 (11.66%), HBsAg reactivity in 10 (3.33%) and rapid plasma regain (RPR) reactivity in 20 (6.66%) cases.
RPR-positive serum samples were confirmed by the treponema pallidum hemaglutination test. Gonococcal infection was not found in any of the FSWs. Of the total of 35 HIV-positive patients, 20 patients had associated coinfection. Of the 35 HIV-seropositive FSWs, BV was detected in six (17.14%), candidiasis in six (17.14%), syphilis in five (14.28%) and HBsAg in two (5.71%). One (2.85%) HIV-positive FSW was positive for both candidiasis and syphilis.

Keywords: HIV, Infections, STD, sex workers

How to cite this article:
Shethwala ND, Mulla SA, Kosambiya J K, Desai VK. Sexually transmitted infections and reproductive tract infections in female sex workers. Indian J Pathol Microbiol 2009;52:198-9

How to cite this URL:
Shethwala ND, Mulla SA, Kosambiya J K, Desai VK. Sexually transmitted infections and reproductive tract infections in female sex workers. Indian J Pathol Microbiol [serial online] 2009 [cited 2014 Dec 26];52:198-9. Available from: http://www.ijpmonline.org/text.asp?2009/52/2/198/48916



   Introduction Top


Sexually transmitted infections are a major public health problem among the women, especially in developing countries. Female sex workers (FSWs) are at a high risk for developing the sexually transmitted diseases (STDs). Both STD (syphilis, trichomoniasis, gonorrhea and Chlamydia infections) and non-sexually transmitted genital infections [candidiasis, bacterial vaginosis (BV)] can have a serious sequel detrimental effect to the health of the women and infants. Further research indicates that both ulcerative STDs (syphilis, herpes, chancroid) and non-ulcerative inflammatory infections (gonorrhea, Chlamydia infection, trichomoniasis, BV) can be cofactors for human immunodeficiency virus (HIV) infections. [1],[2],[3] Understanding the prevalence of these diseases in the high-risk population is important in planning and framing public health policy.


   Materials and Methods Top


A total of 300 FSWs from three different regions of Surat city were included in the study. At the beginning, informed consent was obtained following which a behavioral questionnarie was given. This was followed by examination and specimen collection for laboratory tests. All FSWs were screened for syphilis, gonorrhea, trichomonas, HIV (unlinked anonymous testing) BV, Candida and hepatitis B infections.

Vaginal and cervical specimens were collected during pelvic examination.

For detection of BV, specimens of vaginal exudates were collected with a swab from the posterior fornix of the vagina. The vaginal pH was tested using a vaginal pH strip. A whiff test was performed to detect amine odors and the vaginal fluid was examined microscopically for clue cells. BV was defined according to the Amsel's criteria, [4] i.e. the presence of any three of the following four findings:

  1. Homogenous white vaginal discharge
  2. Clue cell in a high-power field under the microscope (wet mount)
  3. Vaginal pH ≥4.5
  4. Presence of amine odor


A second vaginal swab was taken for detection of BV using Gram staining. A standardized 0-10 scoring system (Nugent's criteria) was used to evaluate BV on the basis of the presence of large Gram-positive rods (Lactobacilli), small Gram-negative rods (Gardnerella) and Mobiluncus. A score equal to or more than 7 was considered positive for BV. [5] High vaginal specimens were examined under a microscope after adding normal saline solution for detecting motile Trichomonas .

For detection of Candida infection, Gram stain preparation from vaginal swabs was screened for the presence of Gram-positive yeast cells and pseudohyphae. One swab taken from the posterior fornix was also inoculated on Sabouraud's dextrose agar. For detection of Gonococci, a direct smear was prepared from the endocervical sample and Gram staining was performed. The slide was viewed under the oil immersion lens. The presence of intracellular Gram-negative diplococci within the polymorphonuclear leucocytes was considered suggestive of gonorrhoea.

The endocervical swab was inoculated immediately on collection on a selective medium: Gonococcal agar media supplemented with vancomycin, colistin and nystatin.


   Results Top


The prevalence of STD among FSW observed in this study is shown in the [Table 1]. HIV associated infections observed in FSW is as shown in [Table 2].


   Discussion Top


The present study shows the prevalence of various infections in FSWs, such as HIV in 35 (11.66%), Hepatitis B in 10 (3.33%), syphilis in 20 (6.66%), Trichomonas in six (2%), Gonococci in 0 (0%), Candida in 31 (10.33%) and BV in 40 (13.33%). Serology for Herpes simplex 1 and 2 and for chlamydia was not performed.

These rates of infection are comparable with the studies by K.G. Santhya [6] among the commercial sex workers in India. Ranges for various infections according to K.G. Santhya were as follows:

Gonococci (0.5-19.1%),

Chlamydia trachomatis (4.6-22.9%),

Syphilis (4.3-63%),

Trichomonas vaginalis (8.8-54.1%),

Herpes simplex virus (7.5-20.0%),

Hepatitis B virus (2.0-12.0%),

HIV (2.6-49.9%).

A similar study of STDs and HIV among women sex workers in Surat conducted in the year 2000 revealed that of the 118 samples tested for trichomoniasis, 13.6% were positive by wet mount microscopy and 14.4% were positive by culture in Whittington media. [7] A similar study conducted at Ahmedabad among women sex workers revealed that of the 134 samples tested for trichomoniasis, wet mount microscopy was positive for 34% and 40.8% were positive by culture in Whittington media. [8]


   Conclusion Top


It was observed from the present study that the rate of HIV is 11.66%, which is quite high in FSWs of Surat city. These HIV-seropositive FSWs also showed other associated coinfections. Of the 35 HIV-seropositive FSWs, six (17.14%) were positive for BV, six (17.14%) had Candida infection, five (14.28%) had positive serology for syphilis and two (5.71%) were positive for hepatitis B surface antigen.

The rate of Trichomonas infection was only 2%. A more sensitive method such as culture would, probably, have detected more cases.

 
   References Top

1.Wasserheit JN. Epidemiological synergy: Inter relationship between human immunodeficiency virus infection and other sexually transmitted diseases. Sex Transm Dis 1992;19:61-77.  Back to cited text no. 1    
2.Laga M, Nzila N, Gaeman J. The inter relationship of sexually transmitted diseases and HIV infection: Implication for the control of both epidemics in Africa. AIDS 1991;5:S55-63.  Back to cited text no. 2    
3.Cohen CR, Duerr A, Pruithithada N, Rugpaos, Hiller SL, Garcia P, et al . Bacterial vaginosis and HIV seroprevalence among female commercial sex workers in chiang Mai, Thailand. AIDS 1995;9:1093-7.  Back to cited text no. 3    
4.Amsel R, Totten PA, Spiegel CS, Chen KC, Eschenbach D, Holmes KK. On specific vaginitis: Diagnostic and microbial and epidemiological associations. Am J Med 1983;74:14-22.  Back to cited text no. 4    
5.Nugent RP, Krohn NA, Hiller SL. Reliability of diagnosing bacterial vaginosis is improved by a standardized method of Gram stain interpretation. J Clin Microbiol 1993;29:297-301.  Back to cited text no. 5    
6.Santhya KG, Grosskurth H, Rangaiyan G. Reproductive tract & sexually transmitted infections. 2003. p. 73-6.  Back to cited text no. 6    
7.Desai VK, Kosambiya JK, Thakor HG, Umrigar DD, Khandwala BR, Bhuyan KK. Prevalence of sexually transmitted infections and performance of STI syndromes against aetiological diagnosis in female sex workers of red light areas in Surat, India. Sex Transm Infect 2003;79:111-5.  Back to cited text no. 7    
8.DFID and FHI prevalence of sexually transmitted infections and HIV among women sex workers of Ahmedabad, Gujarat, Indian Series 2001. p. 24.  Back to cited text no. 8    

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Correspondence Address:
Summaiya A Mulla
B-5, 6 Madni Society, Near Al Fasani School, New Rander Coseway Road, Adajan area, Surat - 395 009
India
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DOI: 10.4103/0377-4929.48916

PMID: 19332911

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    Tables

  [Table 1], [Table 2]

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