title: Periodic presumptive treatment of curable sexually transmitted infections among sex workers:  recent experience with implementation.
abstract: OBJECTIVE
  Curable sexually transmitted infections (STIs) are common occupational hazards for female sex workers in low-income and middle-income countries. Yet, most infections are asymptomatic and sensitive screening tests are rarely affordable or feasible. Periodic presumptive treatment (PPT) has been used as a component of STI control interventions to rapidly reduce STI prevalence.
  
  
  RESULTS
  Six recent observational studies confirm earlier randomized controlled trial findings that PPT reduces gonorrhoea and chlamydia prevalence among sex workers. One modeling study estimated effects on Neisseria gonorrhoeae, Chlamydia trachomatis, Haemophilus ducreyi, and HIV prevalence at different levels of PPT coverage and frequency, among sex workers who take PPT and among all sex workers. Important operational issues include use of single-dose combination antibiotics for high cure rates, conditions for introducing PPT, frequency and coverage, and use of PPT together with other intervention components to maximize and sustain STI control and reinforce HIV prevention.
  
  
  CONCLUSIONS
  PPT is an effective short-term measure to rapidly reduce prevalence of gonorrhoea, chlamydia, and ulcerative chancroid among female sex workers. It should be implemented together with other measures--to increase condom use, reduce risk and vulnerability--in order to maintain low STI prevalence when PPT is phased out.
authors.affiliation: Department of Public Health, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands. steenr7@gmail.com
authors.forename: Richard
authors.initials: R
authors.lastname: Steen
authors.forename: Matthew
authors.initials: M
authors.lastname: Chersich
authors.forename: Sake J
authors.initials: SJ
authors.lastname: de Vlas
mesh_terms: D002690:Chlamydia Infections / Q000453:epidemiology / Q000517:prevention & control; D005260:Female; D006069:Gonorrhea / Q000453:epidemiology / Q000517:prevention & control; D015658:HIV Infections / Q000453:epidemiology / Q000517:prevention & control; D006192:Haemophilus Infections / Q000453:epidemiology / Q000517:prevention & control; D006801:Humans; D015995:Prevalence; D060386:Sex Workers; D012749:Sexually Transmitted Diseases / Q000453:epidemiology / Q000517:prevention & control*