Sexually transmitted infections in male clients of female sex workers in Benin: risk factors and reassessment of the leucocyte esterase dipstick for screening of urethral infections

Abstract

Objectives: (1) To assess risk factors for urethral infections with Chlamydia trachomatis, Neisseria gonorrhoeae, and Trichomonas vaginalis among male clients of female sex workers (FSWs) in Benin; (2) to study the validity of LED testing of male urine samples compared to a highly sensitive gold standard (PCR) for the diagnosis of urethral infections with the organisms cited above. Methods: Male clients of FSWs (n = 404) were recruited on site at prostitution venues in Cotonou, Benin, between 28 May and 18 August 1998. A urine sample was obtained from each participant just before he visited the FSW, and tested immediately using a leucocyte esterase dipstick (LED) test. It was then tested for HIV using the Calypte EIA with western blot confirmation, and for C trachomatis, N gonorrhoeae, and T vaginalis by PCR. After leaving the FSW's room, participants were interviewed about demographics, sexual behaviour, STI history and current symptoms and signs, and were examined for urethral discharge, genital ulcers, and inguinal lymphadenopathies. Results: STI prevalences were: C trachomatis, 2.7%; N gonorrhoeae, 5.4%; either chlamydia or gonorrhoea 7.7%; T vaginalis 2.7%; HIV, 8.4%. Lack of condom use with FSWs and a history of STI were independently associated with C trachomatis and/or N gonorrhoeae infection. Over 80% of these infections were in asymptomatic subjects. The overall sensitivity, specificity, positive and negative predictive values of the LED test for detection of either C trachomatis or N gonorrhoeae were 48.4%, 94.9%, 44.1%, and 95.7%, respectively. In symptomatic participants (n = 22), all these parameters were 100% while they were 47.4%, 94.7%, 37.5%, and 96.4% in asymptomatic men (n = 304). Conclusions: Since most STIs are asymptomatic in this population, case finding programmes for gonorrhoea and chlamydia could be useful. The performance characteristics of the LED test in this study suggest that it could be useful to detect asymptomatic infection by either C trachomatis or N gonorrhoeae in high risk men.

Urine‐based testing forChlamydia trachomatisusing polymerase chain reaction, leucocyte esterase and urethral and cervical smears

“…In a similar study of mainly asymptomatic males with a C. trachomatis prevalence of 10.4 %, the sensitivity of the LE test for predicting a chlamydial infection was only 46 %, while the specificity was 91.6 % and only12 % of patients had a positive LE test [9]. Other studies have reported LE sensitivities of 48-67 % for predicting C. trachomatis infections in males and a single study in females [10][11][12][13]. Thus, the sensitivity of the LE test in our study is higher and the specificity lower than in most other studies.…”

“…The incidence N. gonorrhoeae in the population we have studied is v2 (SMI) and would not be expected significantly to contribute to the outcome, but other microorganisms may be more common. The proportion of asymptomatic patients and whether or not urethral or cervical swabs are obtained before or after urine samples have also been reported to influence the sensitivity of the LE test [9,12].…”

Transactional Sex among Men and Women in the South at High Risk for HIV and Other STIs

“…17,18 In addition, studies of men purchasing sex suggest that they are at increased risk of HIV and other STIs. [19][20][21] Studies of women purchasing sex appear to be very rare, 22 as there do not appear to be any quantitative studies in the literature of risk behaviors or HIV and other STIs among women purchasing sex.…”

“…32,37,38 Moreover, prevalence of HIV and other STIs is substantially higher among men who purchase sex from women than among men who do not purchase sex. [19][20][21] Individuals who sell sex are more likely to engage in high-risk sex with their primary partners 39 ; however, some may engage in unprotected sex with clients as well. 32 Victimization, forced sex, and sexual and physical abuse are associated with transactional sex both historically and in conjunction with engaging in transactional sex.…”

HIV-Related Risk Behaviors and History of Sexually Transmitted Diseases Among Male Migrants Who Patronize Commercial Sex in China

“…8 Another study conducted in Benin, which included urine sample testing from male clients just before they visited FSWs, indicated that 7.7% were infected with either chlamydia or gonorrhea. 9 Miller and colleagues reported from a cross-sectional survey conducted in Lima, Peru, that 86% of clients always used a condom with FSWs and the prevalence of chlamydia and gonorrhea was 2%. 10 Male clients attending STD clinics in Australia reported more sexual partners and more condom use than men who denied any commercial sexual contact; clients were more likely to report a history of STDs than nonclients.…”