Advertisement

AIDS and Behavior

, Volume 22, Supplement 1, pp 19–25 | Cite as

Symptom-Based Versus Laboratory-Based Diagnosis of Five Sexually Transmitted Infections in Female Sex Workers in Iran

  • Armita Shahesmaeili
  • Mohammad Karamouzian
  • Mostafa Shokoohi
  • Kianoush Kamali
  • Noushin Fahimfar
  • Seyed Alireza Nadji
  • Hamid Sharifi
  • Ali Akbar Haghdoost
  • Ali Mirzazadeh
Article

Abstract

Among 1337 Iranian adult female sex workers in 2015, we assessed the diagnostic value of 4 self-reported sexually transmitted infection (STIs) symptoms for detecting laboratory-confirmed gonorrhea, chlamydia, trichomoniasis, human papillomavirus (HPV), and syphilis. While 37.7% reported vaginal discharge (VD), 25.9% reported pain or burning (P/B), 3.0% reported genital ulcers (GU), and 1.4% reported genital warts (GW), the prevalence of laboratory-confirmed syphilis, gonorrhea, chlamydia, trichomoniasis, and HPV was 0.4, 1.3, 6.0, 11.9, and 41.9%, respectively. The sensitivity of VD was 40.3% for detecting tricomoniasis, 37.5% for chlamydia, and 37.5% for gonorrhea. The sensitivity of P/B ranged from 12.5% for gonorrhea to 25.2% for trichomoniasis. The sensitivity of GU and GW was very low for 5 STIs. The sensitivity of all symptoms combined was also lower than 50%. Among asymptomatic participants, 41.2% tested positive for HPV, 11.8% for trichomoniasis, and less than 6.6% for other STIs. Symptom-based case management and surveillance of STIs can lead to misclassification of a large proportion of cases.

Keywords

Sexually transmitted infections Symptoms Diagnostic values Female sex workers 

Notes

Acknowledgements

The authors thank Dr. Parvin Afsar Kazerooni for her insightful comments on original draft of this paper. We would like to acknowledge supervisors and field staff from all collaborative universities who provided inputs to the study design and methods, assisted in data collection and implementation of the survey. Our gratitude also goes to the FSW who participated in the survey.

Funding

The study was funded by the Global Fund to Fight AIDS, Tuberculosis and Malaria through UNDP Iran, and by Ministry of Iran. For this paper, we also received support from the University of California, San Francisco’s International Traineeships in AIDS Prevention Studies (ITAPS), U.S. NIMH, R25MH064712.

Compliance with Ethical Standards

Conflict of interest

All authors declare that they have no conflict of interest.

Ethical Approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Informed Consent

Informed consent was obtained from all individual participants included in the study. The study was anonymous, and no identifying information was collected during recruitment, informed consent, interview, or STIs testing. A unique identification code was provided to participants to help link survey responses to their test results. Participants were able to receive their STIs test results, post-test counseling, and referrals from the local testing and counseling center by providing their unique identification code. FSWs were given 70,000 Rials (equal to ~ 2.5 USD) as an incentive for participating in the study and 30,000 Rials (equal to ~ 1 USD) if they returned to receive their test results. The study protocol was reviewed and approved by the Ethics Committee of Kerman University of Medical Sciences (Ethical Code: K/93/209).

References

  1. 1.
    Newman L, Rowley J, Vander Hoorn S, Wijesooriya NS, Unemo M, Low N, et al. Global estimates of the prevalence and incidence of four curable sexually transmitted infections in 2012 based on systematic review and global reporting. PLoS ONE. 2015;10(12):e0143304.CrossRefPubMedPubMedCentralGoogle Scholar
  2. 2.
    World Health Organization. Report on global sexually transmitted infection surveillance 2015. Geneva; 2016.Google Scholar
  3. 3.
    Gottlieb SL, Low N, Newman LM, Bolan G, Kamb M, Broutet N. Toward global prevention of sexually transmitted infections (STIs): the need for STI vaccines. Vaccine. 2014;32(14):1527–35.CrossRefPubMedGoogle Scholar
  4. 4.
    Ortayli N, Ringheim K, Collins L, Sladden T. Sexually transmitted infections: progress and challenges since the 1994 International Conference on Population and Development (ICPD). Contraception. 2014;90(6):22–31.CrossRefGoogle Scholar
  5. 5.
    Tucker JD, Bien CH, Peeling RW. Point-of-care testing for sexually transmitted infections: recent advances and implications for disease control. Curr Opin Infect Dis. 2013;26(1):73–9.CrossRefPubMedPubMedCentralGoogle Scholar
  6. 6.
    Aledort JE, Ronald A, Rafael ME, Girosi F, Vickerman P, Le Blancq SM, et al. Reducing the burden of sexually transmitted infections in resource-limited settings: the role of improved diagnostics. Nature. 2006;444:59–72.CrossRefPubMedGoogle Scholar
  7. 7.
    Cwikel JG, Lazer T, Press F, Lazer S. Sexually transmissible infections among female sex workers: an international review with an emphasis on hard-to-access populations. Sex Health. 2008;5(1):9–16.CrossRefPubMedGoogle Scholar
  8. 8.
    Mc Grath-Lone L, Marsh K, Hughes G, Ward H. The sexual health of female sex workers compared with other women in England: analysis of cross-sectional data from genitourinary medicine clinics. Sex Trans Infect. 2014;90:344–50.CrossRefGoogle Scholar
  9. 9.
    World Health Organization. Report on global sexually transmitted infection surveillance 2013. Geneva; 2014.Google Scholar
  10. 10.
    Chen Y, Shen Z, Morano JP, Khoshnood K, Wu Z, Lan G, et al. Bridging the epidemic: a comprehensive analysis of prevalence and correlates of HIV, Hepatitis C, and syphilis, and infection among female sex workers in Guangxi Province, China. PLoS ONE. 2015;10(2):e0115311.CrossRefPubMedPubMedCentralGoogle Scholar
  11. 11.
    Kazerooni PA, Motazedian N, Motamedifar M, Sayadi M, Sabet M, Lari MA, et al. The prevalence of human immunodeficiency virus and sexually transmitted infections among female sex workers in Shiraz, South of Iran: by respondent-driven sampling. Int J STD AIDS. 2014;25(2):155–61.CrossRefPubMedGoogle Scholar
  12. 12.
    Roksana J, Fatemeh A. An overview on sexually transmitted infections in Iran. Int J Reprod Contracept Obstet Gynecol. 2016;5(3):585–95.Google Scholar
  13. 13.
    Kassaian N, Ataei B, Yaran M, Babak A, Shoaei P. Hepatitis B and C among women with illegal social behavior in Isfahan, Iran: seroprevalence and associated factors. Hepat Mon. 2011;11(5):368–71.PubMedPubMedCentralGoogle Scholar
  14. 14.
    Shah NS, Kim E, de Maria Hernández Ayala F, Guardado Escobar ME, Nieto AL, Kim AA, et al. Performance and comparison of self-reported STI symptoms among high-risk populations–MSM, sex workers, persons living with HIV/AIDS–in El Salvador. Int J STD AIDS. 2014;25(14):984–91.CrossRefPubMedPubMedCentralGoogle Scholar
  15. 15.
    Kosambiya JK, Baria H, Parmar R, Mhaskar R, Emmanuel P, Kumar A. Diagnostic accuracy of self-reported symptomatic assessment versus per speculum/per vaginal examination for the diagnosis of vaginal/cervical discharge and lower abdominal pain syndromes among female sex workers. Indian J Sex Trans Dis. 2016;37(1):12.CrossRefGoogle Scholar
  16. 16.
    Mirzazadeh A, Haghdoost AA, Nedjat S, Navadeh S, McFarland W, Mohammad K. Accuracy of HIV-related risk behaviors reported by female sex workers, Iran: a method to quantify measurement bias in marginalized populations. AIDS Behav. 2013;17(2):623–31.CrossRefPubMedGoogle Scholar
  17. 17.
    Mirzendehdel S, Nadji SA, Tabarsi P, Baghaei P, Javanmard P, Sigarroodi A, et al. Prevalence of HPV and HIV among female drug addicts attending a drop-in center in Tehran, Iran. Int J Gynecol Obstet. 2010;108(3):254–55.CrossRefGoogle Scholar
  18. 18.
    StataCorp. Stata statistical software: release 15 (Package DIAGT). College Station, TX: StataCorp LLC; 2017.Google Scholar
  19. 19.
    Shaukat S, Kazmi AH. Sexually transmitted infections and syndromic management. J Pak Assoc Dermatol. 2015;25:159–61.Google Scholar
  20. 20.
    Sloan NL, Winikoff B, Haberland N, Coggins C, Elias C. Screening and syndromic approaches to identify gonorrhea and chlamydial infection among women. Stud Fam Plann. 2000;31(1):55–68.CrossRefPubMedGoogle Scholar
  21. 21.
    Otieno FO, Ndivo R, Oswago S, Ondiek J, Pals S, McLellan-Lemal E, et al. Evaluation of syndromic management of sexually transmitted infections within the Kisumu Incidence Cohort Study. Int J STD AIDS. 2014;25(12):851–9.CrossRefPubMedPubMedCentralGoogle Scholar
  22. 22.
    Clark JL, Lescano AG, Konda KA, Leon SR, Jones FR, Klausner JD, et al. Syndromic management and STI control in urban Peru. PLoS ONE. 2009;4(9):e7201.CrossRefPubMedPubMedCentralGoogle Scholar
  23. 23.
    Ghebremichael M. The syndromic versus laboratory diagnosis of sexually transmitted infections in resource-limited settings. ISRN AIDS. 2014;2014:103452.  https://doi.org/10.1155/2014/103452.CrossRefPubMedPubMedCentralGoogle Scholar
  24. 24.
    Yin Y-p WuZ, Lin C, Guan J, Wen Y, Li L, et al. Syndromic and laboratory diagnosis of sexually transmitted infection: a comparative study in China. Int J STD AIDS. 2008;19(6):381–4.CrossRefPubMedPubMedCentralGoogle Scholar
  25. 25.
    Mirzazadeh A, Shokoohi M, Khajehkazemi R, Hosseini Hooshyar S, Karamouzian M, Fahimfar N, et al. HIV and Sexually Transmitted Infections among Female Sex Workers in Iran: Findings from the 2010 and 2015 National Surveillance Surveys. In: Conference SIA, editor. 21st International AIDS Conference; Durban: 21st International AIDS Conference; 2016.Google Scholar
  26. 26.
    Sen S. Syndromic management in the control of sexually transmitted infections: time for a relook. Indian J Dermatol Venereol Leprol. 2013;79(6):816.CrossRefPubMedGoogle Scholar
  27. 27.
    Farley TA, Cohen DA, Elkins W. Asymptomatic sexually transmitted diseases: the case for screening. Prev Med. 2003;36(4):502–9.CrossRefPubMedGoogle Scholar
  28. 28.
    Patterson TL, Volkmann T, Gallardo M, Goldenberg S, Lozada R, Semple SJ, et al. Identifying the HIV transmission bridge: which men are having unsafe sex with female sex workers and with their own wives or steady partners? J Acquir Immune Defic Syndr. 2012;60(4):414.CrossRefPubMedPubMedCentralGoogle Scholar
  29. 29.
    Cárcamo CP, Campos PE, García PJ, Hughes JP, Garnett GP, Holmes KK, et al. Prevalences of sexually transmitted infections in young adults and female sex workers in Peru: a national population-based survey. Lancet Infect Dis. 2012;12(10):765–73.CrossRefPubMedPubMedCentralGoogle Scholar
  30. 30.
    World Health Organization. Guidelines for the management of sexually transmitted infections. Geneva: World Health Organization; 2004.Google Scholar
  31. 31.
    Lalkhen AG, McCluskey A. Clinical tests: sensitivity and specificity. Contin Educ Anaesth Crit Care Pain. 2008;8(6):221–3.CrossRefGoogle Scholar
  32. 32.
    Wariki W, Ota E, Mori R, Koyanagi A, Hori N, Shibuya K. Behavioral interventions to reduce the transmission of HIV infection among sex workers and their clients in low and middle income countries. Cochrane Database Syst Rev. 2012(2):No:CD005272.Google Scholar
  33. 33.
    Sharifi H, Karamouzian M, Baneshi MR, Shokoohi M, Haghdoost A, McFarland W, et al. Population size estimation of female sex workers in Iran: synthesis of methods and results. PLoS ONE. 2017;12(8):e0182755.CrossRefPubMedPubMedCentralGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2018

Authors and Affiliations

  • Armita Shahesmaeili
    • 1
  • Mohammad Karamouzian
    • 1
    • 2
  • Mostafa Shokoohi
    • 1
    • 3
  • Kianoush Kamali
    • 4
  • Noushin Fahimfar
    • 4
  • Seyed Alireza Nadji
    • 5
  • Hamid Sharifi
    • 1
  • Ali Akbar Haghdoost
    • 1
  • Ali Mirzazadeh
    • 1
    • 6
  1. 1.HIV/STI Surveillance Research Center, and WHO Collaborating Center for HIV Surveillance, Institute for Futures Studies in HealthKerman University of Medical SciencesKermanIran
  2. 2.School of Population and Public HealthUniversity of British ColumbiaVancouverCanada
  3. 3.Epidemiology & Biostatistics, Schulich School of Medicine & DentistryThe University of Western OntarioLondonCanada
  4. 4.Department of Epidemiology and Biostatistics, School of Public HealthTehran University of Medical SciencesTehranIran
  5. 5.Virology Research Center, National Institute of Tuberculosis and Lung Diseases (NRITLD)Shahid Beheshti University of Medical SciencesTehranIran
  6. 6.Department of Epidemiology and Biostatistics, Institute for Global Health SciencesUniversity of California, San FranciscoSan FranciscoUSA

Personalised recommendations