title: Sexually transmitted infections and reproductive health morbidity in a cohort of female sex workers screened for a microbicide feasibility study in Nellore, India.
abstract: 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.affiliation: Population Council , New Delhi, Delhi, India. asarna@popcouncil.org
authors.forename: Avina
authors.initials: A
authors.lastname: Sarna
authors.forename: Barbara A
authors.initials: BA
authors.lastname: Friedland
authors.forename: Aylur K
authors.initials: AK
authors.lastname: Srikrishnan
authors.forename: Lauren L
authors.initials: LL
authors.lastname: Katzen
authors.forename: Waimur
authors.initials: W
authors.lastname: Tun
authors.forename: Sharon A
authors.initials: SA
authors.lastname: Abbott
authors.forename: Ulrike
authors.initials: U
authors.lastname: Rawiel
authors.forename: Christine A
authors.initials: CA
authors.lastname: Kelly
authors.forename: C S
authors.initials: CS
authors.lastname: Shalini
authors.forename: Suniti
authors.initials: S
authors.lastname: Solomon
authors.forename: Barbara S
authors.initials: BS
authors.lastname: Mensch
mesh_terms: D000328:Adult; D000890:Anti-Infective Agents / Q000627:therapeutic use*; D015331:Cohort Studies; D005240:Feasibility Studies; D005260:Female; D005782:Gels; D015658:HIV Infections / Q000188:drug therapy / Q000453:epidemiology; D006801:Humans; D007044:Hysterectomy / Q000706:statistics & numerical data; D007194:India / Q000453:epidemiology; D015995:Prevalence; D060728:Reproductive Health / Q000706:statistics & numerical data*; D060386:Sex Workers / Q000706:statistics & numerical data*; D012749:Sexually Transmitted Diseases / Q000188:drug therapy* / Q000453:epidemiology*; D013245:Sterilization, Reproductive / Q000706:statistics & numerical data; D055815:Young Adult
chemical_list: D000890:Anti-Infective Agents; D005782:Gels