title: Periodic presumptive treatment of curable sexually transmitted infections among sex workers:  a systematic review.
abstract: BACKGROUND
  Unprotected sex work remains a major driver of HIV/sexually transmitted infection (STI) epidemics in many countries. STI treatment can lower disease burden, complications and prevalence of HIV cofactors. Periodic presumptive treatment (PPT) has been used with sex workers to reduce their high burden of largely asymptomatic STIs. The objective of this review is to assess benefits and harms of PPT among female sex workers.
  
  
  METHODS
  We searched MEDLINE for studies related to sex work and STIs during 1990-2010, extracted data from eligible studies in duplicate and conducted meta-analysis by study design using random effects models.
  
  
  RESULTS
  Two thousand, three hundred and fifteen articles were screened, 18 studies met inclusion criteria and 14 were included in meta-analyses. One published randomized controlled trial (RCT) reported significant reductions of gonorrhoea (Neisseria gonorrhoeae) [rate ratio (RR) 0.46, 95% confidence interval (CI) 0.31-0.68] and chlamydia (Chlamydia trachomatis) (RR 0.38, 95%CI 0.26-0.57), but no effect on serologic syphilis (RR 1.02, 95%CI 0.54-1.95). Similar results were seen for N. gonorrhoeae and C. trachomatis in pooled analyses, including data from one unpublished RCT and across study designs, and correlated with initial prevalence (R(2) = 0.155). One observational study reported genital ulcer disease (GUD) declines in sex workers, and two reported impact among male client populations for N. gonorrhoeae [odds ratio (OR) 0.60, 95% CI 0.38-0.94], C. trachomatis (OR 0.47, 95% CI 0.31-0.71) and GUD (OR 0.21, 95% CI 0.11-0.42). No studies reported evidence of risk compensation or antibiotic resistance.
  
  
  CONCLUSIONS
  PPT can reduce prevalence of gonorrhoea, chlamydia and ulcerative STIs among sex workers in whom prevalence is high. Sustained STI reductions can be achieved when PPT is implemented together with peer interventions and condom promotion. Additional benefits may include impact on STI and HIV transmission at population level.
authors.affiliation: Department of Public Health, Erasmus MC, University Medical Center Rotterdam, The Netherland. steenr7@gmail.com
authors.forename: Richard
authors.initials: R
authors.lastname: Steen
authors.forename: Matthew
authors.initials: M
authors.lastname: Chersich
authors.forename: Antonio
authors.initials: A
authors.lastname: Gerbase
authors.forename: Graham
authors.initials: G
authors.lastname: Neilsen
authors.forename: Annika
authors.initials: A
authors.lastname: Wendland
authors.forename: Francis
authors.initials: F
authors.lastname: Ndowa
authors.forename: Elie A
authors.initials: EA
authors.lastname: Akl
authors.forename: Ying-Ru
authors.initials: YR
authors.lastname: Lo
authors.forename: Sake J
authors.initials: SJ
authors.lastname: de Vlas
mesh_terms: D000890:Anti-Infective Agents / Q000008:administration & dosage* / Q000009:adverse effects*; D002690:Chlamydia Infections / Q000453:epidemiology / Q000517:prevention & control; D017280:Condoms / Q000706:statistics & numerical data; D005260:Female; D006069:Gonorrhea / Q000453:epidemiology / Q000517:prevention & control; D015658:HIV Infections / Q000453:epidemiology / Q000517:prevention & control; D006801:Humans; D015995:Prevalence; D011322:Primary Prevention / Q000379:methods*; D060386:Sex Workers / Q000706:statistics & numerical data; D012749:Sexually Transmitted Diseases / Q000453:epidemiology* / Q000517:prevention & control*; D016896:Treatment Outcome
chemical_list: D000890:Anti-Infective Agents