title: Symptoms of sexually transmitted infections and care-seeking behaviors of male clients of female sex workers in Bangladesh.
abstract: BACKGROUND
  In Bangladesh, male clients (MCs) of female sex workers (FSWs) represent diverse occupational categories from different socioeconomic strata, and they are considered a bridging group to transmit sexually transmitted infections (STIs) to their spousal and nonspousal female partners. This study aimed to better understand sexual behaviors, STI symptoms, and care-seeking behaviors among MCs of FSWs in Bangladesh.
  
  
  METHODS
  A cross-sectional study was conducted among MCs from November 2005 to July 2006 in 3 types of sex trade settings in Bangladesh. Of 1565 MCs included in this study, 531 were from brothels, 515 from hotels, and 519 from street-based settings.
  
  
  RESULTS
  Among the MCs, 32.2% reported having had STI symptoms within the last 1 year before the interview and 81.5% sought care for those symptoms. Among those who reported symptoms, 44.5% received treatment from pharmacies, 37.4% received treatment from qualified medical professionals, 8.6%, received treatment from nongovernment organization clinics, and 7.8% went to herbal providers. Male clients who had only 1 to 4 years of schooling were 2.4 times more likely to have STI symptoms (adjusted odds ratio [OR], 2.4; 95% confidence interval [CI], 1.5-3.8) compared with the MCs having 10 or more years of schooling. The MCs who had sex with more than 3 nonmarital sexual partners in the last month were 2 times more likely to have STI symptoms (adjusted OR, 2.0; 95% CI, 1.4-2.8). The MCs who used condoms consistently in their non-marital sexual contacts were significantly less likely (adjusted OR, 0.4; 95% CI, 0.3-0.6) to have STI symptoms.
  
  
  CONCLUSIONS
  Reported risk behaviors, STI symptoms and care-seeking behavior suggest that MCs are a potential risk group for transmission of HIV and STIs. The study findings underscore the need to target HIV/STI prevention intervention for MCs, which are predominantly geared toward FSWs.
authors.affiliation: Centre for Reproductive Health, International Centre for Diarrhoeal Disease Research, Bangladesh, Mohakhali, Dhaka, Bangladesh.
authors.forename: Anisuddin
authors.initials: A
authors.lastname: Ahmed
authors.forename: Laura J
authors.initials: LJ
authors.lastname: Reichenbach
authors.forename: Nazmul
authors.initials: N
authors.lastname: Alam
mesh_terms: D000293:Adolescent; D000328:Adult; D001459:Bangladesh / Q000453:epidemiology; D002690:Chlamydia Infections / Q000453:epidemiology / Q000517:prevention & control*; D017280:Condoms / Q000706:statistics & numerical data*; D003430:Cross-Sectional Studies; D004522:Educational Status; D005260:Female; D006069:Gonorrhea / Q000453:epidemiology / Q000517:prevention & control*; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D008297:Male; D008875:Middle Aged; D009790:Occupations; D010342:Patient Acceptance of Health Care / Q000706:statistics & numerical data*; D015995:Prevalence; D012307:Risk Factors; D060386:Sex Workers / Q000706:statistics & numerical data*; D012725:Sexual Behavior / Q000706:statistics & numerical data*