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In the developing world condom use among sex workers and their clients plays a dominant role in the transmission of HIV/STD. In Surabaya, Indonesia, data from the 1993 STD prevalence survey in female sex workers (brothels, street, massage parlours, barber shops, call-girl houses, and nightclubs) reveal that only 5% (33/692) of the brothel workers and 14% (25/177) of the street walkers had condoms in their possession at the time of the interview. During the last paid sexual intercourse, sex workers from the brothels, streets, and nightclubs used condoms infrequently (14%, 20%, and 25%, respectively). Sex workers from massage parlours, barber shops, and call girls were about 5 to 3 times more likely to use condoms than sex workers from nightclubs (adjusted odds ratio of 3.5, 4.9, and 4.2, respectively); thus condom promotion programmes should be targeted at sex workers at brothels, streets, and nightclubs. Programmes should include: (1) free distribution of condoms to sex establishments at the initial stage, and condom social marketing at later stages; (2) penalties, including legal sanctions, against any sex establishments that do not consistently use condoms; (3) participation of brothel owners and madams in encouraging sex workers to consistently have clients use condoms during sexual intercourse; and (4) establishment of sentinel surveillance to monitor STD/HIV and condom-use compliance.

Sex workers and their clients as core groups of high frequency transmitters play a dominant role in the transmission of HIV and other sexually transmitted diseases (STDs). In Surabaya, Indonesia, little is known about the prevalence of STDs in various sex establishments. We conducted an STD prevalence survey of 1873 female sex workers in Surabaya, Indonesia. We did not find any sex workers with HIV infection. Prevalence rates of other STDs (chlamydia, gonorrhoea, serological test for syphilis positive, and/or trichomoniasis) in female sex workers were 48% in brothels (n = 696), 42% on the streets (n = 192), 16% in massage parlours (n = 344), 25% in barber shops (n = 150), 17% at call-girl houses (n = 73), and 10% in nightclubs (n = 418). Sex workers from the brothels had the highest prevalence rates of gonorrhoea (24%) and trichomoniasis (8%), while sex workers from the streets and the barber shop had the highest rates of serological test for syphilis (STS) positive (30%) and chlamydia (18%). STD rates decreased with an increase in age (except for STS positive), an increase in education, a decrease in the number of sex partners, and condom use in the previous week. Condom use in the previous week was universally low among sex workers, especially among sex workers from the brothels (14%). Sex workers from the brothels had STD rates about 4 times higher than sex workers from the nightclubs (adjusted odds ratio of 4.4). Although the HIV seroprevalence rate is currently low, widespread prostitution and high rates of STDs in sex workers warrant programmes to avert a potential explosion of HIV transmission. Because sex workers from the brothels in Surabaya have high rates of STDs and low use of condoms but good cooperation with local authorities, STD preventive measures should focus on this group.

Until recently, the only common strains of antimicrobial agent-resistant Neisseria gonorrhoeae detected in Indonesia were penicillinase-producing N. gonorrhoeae (PPNG) strains. Despite the spread of resistance to other antimicrobial agents among N. gonorrhoeae in Southeast Asia, surveillance for such resistance in Indonesia has been limited. We evaluated the in vitro susceptibilities of 86 N. gonorrhoeae isolates from female sex workers in Surabaya, Indonesia, to 13 antimicrobial agents. Of the 86 isolates, 89% were resistant to penicillin (MIC, .2.0 jig/ml), 98% were resistant to tetracycline (MIC, .2.0 ,ug/ml), 18.1% were resistant to spectinomycin (MIC, .128.0 ,ug/ml), and 97.7% showed decreased susceptibility to thiamphenicol (MIC, 1 to 2 ,ug/ml). Thus, thiamphenicol and spectinomycin may be approaching the end of their usefulness as the drugs of choice for the treatment of gonococcal infections in Surabaya. While the susceptibilities of N. gonorrhoeae to cephalosporins (ceftriaxone, cefixime, and cefoxitin) and fluoroquinolones (ciprofloxacin and ofloxacin) are universal, these drugs have not been used because they are more expensive in Indonesia than thiamphenicol. We conclude that Surabaya had the highest reported rate of penicillin and tetracycline resistance among the Southeast Asian countries and that cephalosporins or fluoroquinolones should be reasonable alternatives for the treatment of gonorrhea in this locale.