Prevalence of gonococcal and chlamydial infections in commercial sex workers in a Peruvian Amazon city

Abstract

Background: Iquitos Peru, a densely populated port city housing both a large military base and a booming tourist industry, provides a thriving market for commercial sex and, consequently, sexually transmitted disease (STD). The purpose of this study was to characterize the prevalence of gonococcal and chlamydial infections among commercial sex workers (CSWs) and to correlate those findings with social/behavioral characteristics.

Methods: One hundred CSWs, recruited through street and brothel outreach, were administered questionnaires. Urine specimens were collected for gonorrhea and chlamydia testing using ligase chain reaction assays.

Results: Twenty-eight percent of CSWs were positive for chlamydia (22%) or gonorrhea (14%). Registered CSWs were more likely to have worked more than 5 years (p = 0.03), report 10 or more partners (p = 0.002), and work in brothels (p < 0.001). Significant associations were also noted between infection status and age, with adolescents at increased risk (odds ratio [OR] = 4.13, p = 0.001), and duration of employment, with those employed less than 5 years at increased risk (OR = 3.72, p = 0.04). The latter association, however, was because of age. Also, most CSWs believed themselves to be at no/small risk or didn't know their risk of future gonococcal infection (30%/12% and 25%, respectively) and AIDS (25%/8% and 35%, respectively), with 11% perceiving AIDS as more of a threat.

Conclusions: High infection rates, lack of knowledge regarding STD/HIV risk assessment, and other high-risk behavior prevalent among this population stress the need for STD intervention. The study further suggests that educational/risk assessment programs and risk reduction interventions could be successful.

PIP: This study aims to characterize the prevalence of gonococcal and chlamydial infections among commercial sex workers (CSWs) in Iquitos, Peru, which provides a thriving market for CSWs and, consequently, sexually transmitted diseases (STDs) and to correlate those findings with social/behavioral characteristics. About 100 CSWs, recruited through street (n = 37) and brothel outreach (n = 67), were interviewed through questionnaires. Urine specimens were collected for gonorrhea and chlamydial testing. Findings revealed that registered CSWs were significantly more likely to have worked in the sex trade for more than 5 years, report 10 or more sex partners per week, and to work in brothels. Nonetheless, there were no significant differences in age, average charge for sex, or STD prevalence between registered and unregistered CSWs. Overall, 28% of CSWs were positive for chlamydia (22%) and gonorrhea (14%). Furthermore, a number of CSWs stated that they did not know whether they were at risk or assessed their risk as being low for contracting gonorrhea or AIDS. There was no significant association between self-perception of STD risk and STD prevalence. High infection rates, lack of knowledge regarding HIV/AIDS and STD risk assessment, and other high-risk behaviors prevalent among this population stress the need for STD intervention programs and risk reduction behavior.