Sexually transmissible infections among female sex workers: an international review with an emphasis on hard-to-access populations
Julie G. Cwikel A D , Tal Lazer B , Fernanda Press B C and Simcha Lazer B C
+ Author Affiliations
- Author Affiliations
A The Center for Women’s Health Studies and Promotion, Ben-Gurion University of the Negev, Beer-Sheva 84105, Israel.
B Department of Obstetric and Gynecology, Soroka University Medical Center, Faculty of Health Sciences, Ben Gurion University of the Negev, Beer-Sheva 84105, Israel.
C Women’s Health Center, Clalit Medical Services, Beer-Sheva 84105, Israel.
D Corresponding author. Email: jcwikel@bgu.ac.il
Sexual Health 5(1) 9-16 https://doi.org/10.1071/SH07024
Submitted: 18 April 2007 Accepted: 23 October 2007 Published: 22 February 2008
Abstract
Background: Women who work commercially in sex work (female sex workers [FSW]) are considered a high-risk group for sexually transmissible infections (STI), yet the level of reported pathogens varies in studies around the world. This study reviewed STI rates reported in 42 studies of FSW around the world published between 1995 and 2006 and analysed the trends and types of populations surveyed, emphasising difficult to access FSW populations. Methods:Studies were retrieved by PUBMED and other search engines and were included if two or more pathogens were studied and valid laboratory methods were reported. Results: The five most commonly assessed pathogens were Neisseria gonorrhea (prevalence 0.5–41.3), Chlamydia trachomatis (0.61–46.2), Treponema pallidum (syphilis; 1.5–60.5), HIV (0–76.6), and Trichomonas vaginalis (trichmoniasis; 0.11–51.0). Neisseria gonorrhea and C. trachomatis were the most commonly tested pathogens and high prevalence levels were found in diverse areas of the world. HIV was highly prevalent mostly in African countries. Although human papillomavirus infection was surveyed in few studies, prevalence rates were very high and its aetiological role in cervical cancer warrant its inclusion in future FSW monitoring. Hard-to-access FSW groups tended to have higher rates of STI. Conclusions: The five most commonly detected pathogens correspond to those that are highly prevalent in the general population, however there is an urgent need to develop rapid testing diagnostics for all five pathogens to increase prevention and treatment, especially in outreach programs to the most vulnerable groups among FSW.
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† †The issue of reliability in reporting behaviour and health status is a research concern in STI studies. Migrant FSW may be less aware of the ‘social desirability’ of reporting consistent condom use and thus may report inconsistent use more often than native FSW.
‡ ‡It is important to remember that FSW working in different regions of the world work in very different conditions with regard to legal, social and environmental protection and the quality and access to general health care and sexual health services.
