Symptom-Based Versus Laboratory-Based Diagnosis of Five Sexually Transmitted Infections in Female Sex Workers in Iran
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.
KeywordsSexually transmitted infections Symptoms Diagnostic values Female sex workers
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.
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.
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 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).
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