STI tests and proportion of positive tests in female sex workers attending local public health departments in Germany in 2010/11

Abstract

BackgroundIn Germany, local public health departments (LPHD) are required to offer low-threshold access to confidential counselling and testing for sexually transmitted infections (STI) for sex workers. We collected data from LPHD in Germany to estimate the number of performed STI tests and the proportion of positive STI tests among attending female sex workers (FSW) in order to formulate recommendations for improving STI testing and care for FSW in Germany.MethodsWe recruited LPHD across Germany to collect aggregated data on attending FSW between January 2010 and March 2011. Baseline characteristics, the number of attending FSW, STI tests (HIV, Chlamydia trachomatis, Neisseria gonorrhoea, syphilis and Trichomonas vaginalis) and the number of positive results were provided by participating LPHD. We described the number of STI tests per FSW visit and the proportion of positive test results, including interquartile range (IQR). We tested whether baseline characteristics of LPHD were associated with the proportion of positive test results.ResultsOverall, 28 LPHD from 14 of the 16 federal states reported 9284 FSW visits over the study period, with a median of 188 FSW visits (IQR 45–440) per LPHD. Overall, a median of 77.1% (IQR 60.7–88.0) of visiting FSW received a test for Neisseria gonorrhoea, followed by HIV (66.0%, IQR 47.9–86.8), Chlamydia trachomatis (65.4%, IQR 50.7–83.6) and syphilis (61.6, IQR 48.6–78.6). In total, 22,914 STI tests were performed. The proportion of positive tests was 3.1% (IQR 1.3–4.8), with the highest proportion of positive tests for Chlamydia trachomatis (6.8%, IQR 2.5–10.4), followed by Neisseria gonorrhoea (3.2%, IQR 0.0–5.3), Trichomonas vaginalis (3.0%, IQR 0.0–15.4), syphilis (1.1%, IQR 0.0–1.3) and HIV (0.2%, IQR 0.0–0.4). The proportion of positive tests varied between 0 and 13.9% between LPHD, with a higher variation of proportion of positive tests in LPHD with a smaller number of reported STI tests.ConclusionsParticipating LPHD varied in terms of performed STI tests and FSW visits. The proportion of positive STI tests was low, but varied between LPHD. This variation likely reflects different testing strategies. Existing testing guidelines should be used by all LPHD to ensure high quality care for FSW.Electronic supplementary materialThe online version of this article (doi:10.1186/s12889-016-3847-6) contains supplementary material, which is available to authorized users.

Uptake and Correlates of Chlamydia and Gonorrhea Testing among Female Sex Workers in Southern China: A Cross-sectional Study

“…In our study, chlamydia and gonorrhea testing rates are much lower than those reported in Germany (77.1% and 65.4%) [20] and previously reported among men who have sex with men (MSM) in China (28.5% and 30.6%) [2]. Additionally, FSW in this study reported high levels of inconsistent condom use (34.6%), and this rate was similar to that in a systematic review among FSW in China [21], exposing them to the risk of contracting or transmitting HIV and frequent STD [22].The low rates of testing uptake alongside highly risky sexual behaviors among FSW highlight the importance of promoting frequent testing among FSW in China.…”

“…The primary outcome of this study was the testing rates of chlamydia and gonorrhea in the past twelve months. A previous study reported a detection rate of 65.4% for chlamydia and 77.1% for gonorrhea among FSW [11].We applied Two-sided Con dence Intervals for One Proportion method to estimate a sample size of 957 for this study to produce a two-sided 95% con dence interval with a width equal to 0.060. According to the number of FSW at each city, the total number of study participants at each city ranged from 200 to 300.…”

“…Testing is a cost-effective strategy to prevent chlamydia and gonorrhea infection among FSW [9]. However, the current sexually transmitted disease (STD) prevention services in low and middle-income countries (LMIC) are mainly focused on controlling HIV and syphilis [10],including China, while to date, limited studies are examining the chlamydia and gonorrhea testing uptake among FSW [11,12]. Previous study in United States and Vietnam indicated that the asymptomatic infection of chlamydia and gonorrhea [13], low levels of knowledge [14], misperceptions of risk, stigma around STD [15], and cost [16] are the main barriers for improving testing uptake of chlamydia and gonorrhea among sexually active women.…”

Trichomonas vaginalis is very rare among women with vaginal discharge in Podlaskie province, Poland

“…This is in concordance with recent results from other EU settings, also with the use of NAATs, which have shown exceedingly low prevalence of T. vaginalis infections in women, ranging from 0% (community clinic attendees in England), through 0.16% (STI clinic in Sweden) up to 0.8% and 1.3% (genitourinary clinic in England and lowrisk childbearing women in Italy, respectively) (8,12,13). Even among female sex workers in Germany, the prevalence has been shown to be as low as 3% (10). Only in females attending prison genitourinary clinic in England, a higher prevalence (10.8%) has been reported (12).…”

“…Recent studies on women attending STI clinics in the USA have showed very high prevalences (15–27%) of T. vaginalis , and associations with ethnicity (Black race), higher ages (peak of T. vaginalis prevalence between 40 and 50 years), low socioeconomic standards and access to health care were described . In contrast, several recent NAAT‐based studies performed in European Union (EU) settings have indicated that trichomoniasis is currently a rare condition, even in high‐risk groups . However, a limited number of studies have been performed in the EU using the highly sensitive and specific APTIMA Trichomonas vaginalis assay (Hologic, San Diego, CA, USA), which was the first NAAT for detection of T. vaginalis approved by the US Food and Drug Association (FDA).…”