Sexually transmissible infections among female sex workers in Manado, Indonesia, using a multiplex polymerase chain reaction-based reverse line blot assay
Ferra O. Mawu A , Stephen C. Davies B F , Michelle McKechnie C , Endang R. Sedyaningsih D , Asti Widihastuti E and Richard J. Hillman CA Faculty of Medicine, University of Sam Ratulangi, Manado, 95115 Sulawesi Utara, Indonesia.
B Northern Sydney Sexual Health Service, Royal North Shore Hospital, St Leonards, NSW 2065, Australia.
C Sexually Transmitted Infections Research Centre, University of Sydney, Marian Villa, Westmead Hospital, Westmead, NSW 2145, Australia.
D National Institute of Health Research and Development, Jakarta 10560, Indonesia.
E Indonesian Planned Parenthood Association (North Sulawesi branch), Jl. Ahmad Yani, 14 Lrg. GPDI Sario Tumpaan Manado, Indonesia.
F Corresponding author. Email: sdavies@nsccahs.health.nsw.gov.au
Sexual Health 8(1) 52-60 https://doi.org/10.1071/SH10023
Submitted: 23 February 2010 Accepted: 15 June 2010 Published: 24 January 2011
Abstract
Background: Sexually transmissible infections (STIs) remain highly prevalent, and HIV is increasing, among female sex workers (FSWs) in Indonesia. Our aim was to determine the prevalence of, and risk factors for, STIs among FSWs in Manado, Indonesia. Methods: We recruited FSWs mainly at their workplace: they completed a questionnaire and provided a urine sample and self-collected vaginal swab. Samples were tested using multiplex polymerase chain reaction, followed by reverse line blot hybridisation. Results: We recruited 221 FSWs, (median age: 25 years). During the previous 3 months, 30% reported never using condoms; only 2.7% always used condoms. Of 217 women with urine samples, 49% had a ‘curable STI’: 10.6% with gonorrhoea, 26.7% with chlamydia, 12.4% with Mycoplasma genitalium and 22.6% with trichomoniasis. Independent risk factors for gonorrhoea were: domiciled outside North Sulawesi (P = 0.001) and age 16–25 years (P = 0.02); for chlamydia: no prior history of STI symptoms (P = 0.003) and age 16–25 years (P = 0.02); for Mycoplasma genitalium: number of clients on last day of sex work (P = 0.004); for trichomoniasis: number of clients per week (P = 0.04). When these four infections were grouped as any ‘curable STI’, independent associations were: number of clients on the last day of sex work (P = 0.001), age 16–25 years (P = 0.02) and sex working for fewer than 2 years (P = 0.03). Conclusions: This is the first report of M. genitalium infection in Indonesia. The high prevalence of STIs and low condom use among these FSWs suggest their vulnerability to the HIV epidemic in Indonesia. They need enhanced interventions, including outreach screening, and periodic presumptive treatment.
Additional keywords: chlamydia, gonorrhoea, mycoplasma, trichomoniasis.
Acknowledgements
The authors thank the health authorities in Indonesia for permission to undertake this study, particularly the Ministry of Health, Jakarta, Indonesia, for approval to transfer specimens to Australia. We thank the staff of Indonesian Planned Parenthood Association (North Sulawesi Chapter, Manado) and of Klinik Pinaesaan YBHK, Manado. We thank the following: Professor Adrian Mindel, University of Sydney and Professor Winsy Warouw, Faculty of Medicine, Sam Ratulangi University, Manado, for approvals; Professor Dr Sarah Warouw, Dean of Faculty of Medicine of Sam Ratulangi University, for assistance in transfer of specimens; Leo McHugh, mathematician, and Dr Karen Byth-Wilson, consultant statistician for assistance in statistical analysis; AusAID, for sponsoring the transport of specimens; CIDM Public Health ICPMR laboratory, Westmead Hospital, for the specimen collection kits and for testing specimens; PT Dexa Medica and PT Guardian Pharmatama in Indonesia, for providing antibiotics; Enersol and Boehringer in Sydney, Australia, for providing condoms; Dr Graham Neilsen of Family Health International and Dr Anna McNulty of the Sydney Sexual Health Centre, for critical review of a draft treatise manuscript. We are grateful to the women who participated.
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