Sexually transmitted infections and reproductive health morbidity in a cohort of female sex workers screened for a microbicide feasibility study in Nellore, India.

Abstract

UNLABELLED:

Women constitute 38% of India's 2.4 million HIV-infected persons. Microbicides are potential HIV-prevention products currently undergoing clinical trials for efficacy. A four-month placebo vaginal gel trial was conducted in Nellore, India to determine the feasibility of recruiting a suitable cohort of female sex workers (FSWs) for a future vaginal microbicide efficacy trial. We report on the HIV and STI prevalence and reproductive health (RH) morbidity of FSWs screened for the trial.  

RESULTS:

529 FSWs completed screening procedures; of those 33.6% were found ineligible.  The mean age was 30.9 years; 68.6% women were married and 57.5% were home-based FSWs.  Self-reported symptoms included abnormal vaginal discharge (31.6%), genital itching (3.4%), uterine mass/prolapse (3%) and painful intercourse (2.6%).  Gynecological surgery was reported by 73.2% of participants; of those 10.5% had undergone a hysterectomy. Female sterilization was the most commonly reported contraceptive method. Pelvic examination showed vaginal discharge (50.7%), cervical discharge (5.3%), uterine/vaginal wall prolapse (2.6%), and cervical mass/nodule/vesicles/genital warts (4.2%). Common epithelial findings included erythema (79.1%) and vesicles/bullae (6%); 46% of participants had Papanicolaou tests graded as inflammatory and 1.1% as malignant. HSV-2 was the mostly commonly detected STI (60.7%) followed by HIV (5.3%), syphilis (2.8%), chlamydia (2.2%), gonorrhoea (0.7%) and trichomoniasis (15.5%).  RTIs were more common: bacterial vaginosis (27.8%) and candidiasis (18.9%).

CONCLUSIONS:

 The low HIV prevalence and high RH morbidity in the population makes this site unsuitable for a future phase 2 or 3 microbicide efficacy trial.  HIV prevention programs targeting this population should include access to RH services.

• Authors: Avina Sarna, Barbara A Friedland, Aylur K Srikrishnan, Lauren L Katzen, Waimur Tun, Sharon A Abbott, Ulrike Rawiel, Christine A Kelly, C S Shalini, Suniti Solomon, Barbara S Mensch
• Journal: Global journal of health science (Glob J Health Sci) Vol. 5 Issue 3 Pg. 139-49 (Feb 24 2013) ISSN: 1916-9736 [Print] Canada
• PMID: 23618483 (Publication Type: Journal Article, Research Support, N.I.H., Extramural)

Chemical References

• Anti-Infective Agents
• Gels

Topics

• Adult
• Anti-Infective Agents (therapeutic use)
• Cohort Studies
• Feasibility Studies
• Female
• Gels
• HIV Infections (drug therapy, epidemiology)
• Humans
• Hysterectomy (statistics & numerical data)
• India (epidemiology)
• Prevalence
• Reproductive Health (statistics & numerical data)
• Sex Workers (statistics & numerical data)
• Sexually Transmitted Diseases (drug therapy, epidemiology)
• Sterilization, Reproductive (statistics & numerical data)
• Young Adult