Division of Infectious Diseases and Infection Control, Cantonal Hospital St. Gallen, Switzerland.
labormedizinisches zentrum Dr Risch AG, Buchs, Switzerland.
Swiss Med Wkly. 2020 Dec 31;150:w20393. doi: 10.4414/smw.2020.20393. eCollection 2020 Dec 14.
In Switzerland, universal health insurance does not cover any routine testing for sexually transmitted infections (STIs), not even in individuals at high risk, and extra-genital swabbing is not standard of care. We compared STI prevalence in a multicentre prospective observational cohort of multi-partner women with/without sex work and evaluated associated risk factors.
Between January 2016 and June 2017, we offered free STI testing to women with multiple sexual partners (three or more in the previous 12 months), with follow-up examinations every 6 months. We used multiplex polymerase chain-reaction testing (for Neisseria gonorrhoeae, Chlamydia trachomatis, Trichomonas vaginalis, Mycoplasma genitalium) for pooled swabs (pharynx, urethra/vagina, anus), and antibody tests for human immunodeficiency virus (HIV) and Treponema pallidum at every visit, and for hepatitis B and C at baseline.
We screened 490 female sex workers (FSWs), including 17 trans women, and 92 other multi-partner women. More than half reported a steady partner. Previously undiagnosed HIV was found in 0.2% vs 0.0%, respectively, and T. pallidum antibodies in 5.9% vs 0.0%. STIs requiring antibiotic treatment comprised: active syphilis 1.2% vs 0.0%; N. gonorrhoeae 4.9% vs 0.0%; C. trachomatis 6.3% vs 5.4%, T. vaginalis 10.4% vs 0.0%; M. genitalium 6.7% vs 6.5%. One in four FSWs vs one in nine other women had one or more of these STIs at baseline. 15.8% vs 3.8% had a history of hepatitis B, 45.5% vs 22.8% had no immunity (HBs-AB <10 IU/l). Two FSWs had hepatitis C virus antibodies (0.4%) without concurrent HIV infection. Non-condom-use (last three months) for anal/vaginal sex was not associated with STIs. Independent risk factors were group sex (adjusted odds ratio [aOR] 2.1, 95% confidence interval [CI] 1.1–4.0), age less than 25 (aOR 3.7, 95% CI 1.6–8.9), and being active in sex work for less than 1 year (aOR 2.7, 95% CI 1.3–5.3).
HIV and HCV do not appear to pose a major public health problem among FSWs in Switzerland, whereas vaccination against HBV should be promoted. FSWs showed high rates of STIs requiring treatment to reduce transmission to clients and/or steady partners. FSWs should be offered low-cost or free STI screening as a public health priority.
在瑞士，全民健康保险不涵盖任何性传播感染（STI）的常规检测，即使是高危人群也不例外，而且外阴拭子检查也不是常规护理。我们比较了多中心前瞻性观察队列中多性伴女性（过去 12 个月内有 3 个性伴或以上）中 STI 的患病率，并评估了相关的危险因素。
2016 年 1 月至 2017 年 6 月，我们为有多个性伴的女性（过去 12 个月内有 3 个性伴或以上）提供免费的 STI 检测，并每 6 个月进行一次随访检查。我们使用多重聚合酶链反应检测（用于淋病奈瑟菌、沙眼衣原体、阴道毛滴虫、生殖支原体）进行混合拭子（咽、尿道/阴道、肛门）检测，并在每次就诊时进行人类免疫缺陷病毒（HIV）和梅毒螺旋体抗体检测，以及在基线时进行乙型肝炎和丙型肝炎检测。
我们筛查了 490 名女性性工作者（FSWs），包括 17 名跨性别女性和 92 名其他多性伴女性。超过一半的人报告有稳定的伴侣。分别发现了 0.2%和 0.0%的之前未诊断出的 HIV，以及 5.9%和 0.0%的梅毒螺旋体抗体。需要抗生素治疗的 STIs 包括：活动性梅毒 1.2%和 0.0%；淋病奈瑟菌 4.9%和 0.0%；沙眼衣原体 6.3%和 5.4%；阴道毛滴虫 10.4%和 0.0%；生殖支原体 6.7%和 6.5%。四分之一的 FSWs 和九分之一的其他女性在基线时有一个或多个这些 STIs。15.8%和 3.8%有乙型肝炎病史，45.5%和 22.8%无免疫力（HBs-AB <10 IU/l）。两名 FSW 有丙型肝炎病毒抗体（0.4%），但没有同时感染 HIV。过去三个月无保护性行为（肛交/阴道交）与 STIs 无关。独立的危险因素是群交（调整后的优势比 [aOR] 2.1，95%置信区间 [CI] 1.1–4.0），年龄小于 25 岁（aOR 3.7，95% CI 1.6–8.9），以及从事性工作不到 1 年（aOR 2.7，95% CI 1.3–5.3）。
HIV 和 HCV 似乎在瑞士的 FSWs 中没有造成重大的公共卫生问题，而乙型肝炎疫苗接种应该得到推广。FSWs 表现出高比例的需要治疗的 STIs，以减少向客户和/或稳定伴侣的传播。应该将 FSWs 的低成本或免费 STI 筛查作为公共卫生的重点。
