A cross-sectional study of reported symptoms for sexually transmissible infections among female sex workers in Papua New Guinea.
BACKGROUND
Sexually transmissible infections (STIs) are common in female sex workers (FSWs), most of which are asymptomatic and therefore under-reported. Our aim was to determine the sensitivity and specificity of reported symptoms obtained via questionnaire augmented with leukocyte esterase (LE) urine dipstick test for the detection of Chlamydia trachomatis (Ct), Neisseria gonorrhea (Ng) and Trichomonas vaginalis (Tv) detected using polymerase chain reaction (PCR).


METHODS
In November 2003, a cohort of FSWs was screened for STIs and completed a questionnaire.


RESULTS
We enrolled 129 FSWs (90% participation rate) of whom 48 (37%), 30 (23%) and 53 (41%) were diagnosed with Ng, Ct and Tv, respectively, by PCR. Of those diagnosed with any of these infections, 78% reported anogenital symptoms and of those without infections, 28% reported symptoms. Anogenital symptoms were present in over 50% FSWs. Genital odour (present in 26%), lower abdominal pain (present in 29%), dysuria (present in 19%) had a sensitivity around (50%), specificity (>80%) and all were significantly associated with positive PCR results for individual organisms; however, the sensitivity of these symptoms to detect the presence of any positive PCR result was low (<50%). When LE urine dipstick test result of >1 was combined with the presence of three reported symptoms the sensitivity was 86%, specificity of 73% and a positive predictive value of 72%; a better predictor of infections.


CONCLUSIONS
Our finding suggest an approach that incorporates LE urine dipstick test >1 and multiple symptoms may be a feasible option for screening infections among FSWs in resource constraint settings.
Melbourne Sexual Health Centre, School of Population Health, The University of Melbourne, Vic., Australia. ebruce@mshc.org.au
Eunice
E
Bruce
Ludwina
L
Bauai
Andrew
A
Masta
Poyap J
PJ
Rooney
Michael
M
Paniu
Mathias
M
Sapuri
Louise
L
Keogh
John
J
Kaldor
Christopher K
CK
Fairley
D000328:Adult; D002690:Chlamydia Infections / Q000175:diagnosis / Q000453:epidemiology; D002692:Chlamydia trachomatis / Q000302:isolation & purification; D003430:Cross-Sectional Studies; D005260:Female; D006069:Gonorrhea / Q000175:diagnosis / Q000453:epidemiology; D006801:Humans; D008403:Mass Screening / Q000706:statistics & numerical data; D008875:Middle Aged; D015999:Multivariate Analysis; D009344:Neisseria gonorrhoeae / Q000302:isolation & purification; D010219:Papua New Guinea / Q000453:epidemiology; D016133:Polymerase Chain Reaction / Q000379:methods; D012680:Sensitivity and Specificity; D011477:Sex Work / Q000706:statistics & numerical data*; D012749:Sexually Transmitted Diseases / Q000175:diagnosis* / Q000453:epidemiology*; D013587:Syphilis / Q000175:diagnosis / Q000453:epidemiology; D014247:Trichomonas Vaginitis / Q000175:diagnosis / Q000453:epidemiology; D014626:Vaginal Smears / Q000706:statistics & numerical data*; D016387:Women's Health; D014931:Women, Working / Q000706:statistics & numerical data; D055815:Young Adult