Periodic presumptive treatment of curable sexually transmitted infections among sex workers

Department of Public Health, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands.
Current Opinion in Infectious Diseases (Impact Factor: 5.01). 12/2011; 25(1):100-6. DOI: 10.1097/QCO.0b013e32834e9ad1
Source: PubMed


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.
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.
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.

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    • "Such services, with their consequent reduction in the burden of HIV and other STIs among sex workers, should be prioritised within all HIV epidemic settings. Reducing these burdens would markedly improve the health of sex workers, but also, evidence suggests (Steen, Chersich, and de Vlas 2012; WHO 2012), might interrupt transmission of these infections among their clients and the general population. This paper reports on a study in four countries of east and southern Africa that examined female, male and transgendered sex workers' experiences of seeking public and private healthcare, barriers to accessing these services and perspectives on how services might better address their needs. "
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    • "Genital ulcer was reported as a self-reported history thus could be susceptible to social desirability bias with women being more prone to underreporting than men. Furthermore, genital ulcers in women are less likely to be diagnosed as they are not easily visible as in men and are generally painless [5], [62], [63]. We did not see a difference in the relationship between HIV and genital ulcer for men and women. "
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