Escuela de Medicina, Universidad Internacional del Ecuador, Quito, Ecuador.
Institute for Infection and Immunity, St George's University of London, London, UK.
Sex Transm Infect. 2024 Nov 18;100(8):504-511. doi: 10.1136/sextrans-2023-056075.
Anorectal sexually transmitted infections (STIs) such as (CT) and (NG), present treatment challenges, potentially increase antibiotic resistance selection and if undetected may facilitate onward transmission. However, there are limited global prevalence data for anorectal STIs. We conducted a cross-sectional study to assess the prevalence and risk factors of non-viral genital and extragenital STIs in female sex workers (FSW) and female non-sex workers (NSW) in Ecuador.
250 adult street and brothel FSWs and 250 NSWs, recruited from settlements in north-west Ecuador provided oropharyngeal and vulvo-vaginal swabs (VVS) as well as socio-demographic data. FSWs also provided anorectal swabs. PCR was used to detect CT, NG, (MG) from all swabs and additionally (TV) from VVS. Risk factors were analysed using logistic regression.
Prevalence of FSW vaginal, anorectal and oropharyngeal infection was 32.0% (95% CI 26.5% to 38.0%), 19.7% (95% CI 15.1% to 25.2%) and 3.2% (95% CI 1.6% to 6.2%), respectively, with most vaginal infections being TV (23.4%; 95% CI 18.5% to 29.2%). Overall FSW STI prevalence, at any anatomical site was 39.7% (95% CI 33.8% to 46.1%), with 12.1% (95% CI 8.5% to 16.9%) of infections detected only at the anorectum. Of all the CT and/or NG infections, 64.4% (95% CI 50.4% to 78.4%) were detected only at the anorectum. STI prevalence in NSWs in the vagina and oropharynx were 5.6% (95% CI 3.4% to 9.2%) and 0.8% (95% CI 0.2% to 2.9%), respectively, with most vaginal infections being MG (3.2%; 95% CI 1.6% to 6.2%). In multivariable analysis, risk factors among brothel-based FSWs for having an anorectal STI were vaginal CT, NG or MG (p<0.001), vaginal TV (p=0.029) and being 'in a relationship' (p=0.038).
High prevalence of CT and NG detected only at the anorectum in these FSWs indicate the possibility of missing significant infections if providing only genital testing and calls for greater research into the potential impact on global STI estimates if extragenital infections among at-risk women are not identified.
肛门直肠性传播感染（STIs），如衣原体（CT）和淋病奈瑟菌（NG），治疗存在挑战，可能增加抗生素耐药性的选择，如果未被发现，可能会促进进一步传播。然而，全球关于肛门直肠 STIs 的流行率数据有限。我们进行了一项横断面研究，以评估厄瓜多尔女性性工作者（FSW）和女性非性工作者（NSW）中生殖器和非生殖器性 STIs 的流行率和危险因素。
从厄瓜多尔西北部的定居点招募了 250 名成年街头和妓院性工作者（FSW）和 250 名非性工作者（NSW），他们提供了口咽和阴道-外阴拭子（VVS）以及社会人口统计学数据。FSW 还提供了肛门直肠拭子。PCR 用于检测所有拭子中的 CT、NG、（MG），并从 VVS 中额外检测 （TV）。使用逻辑回归分析危险因素。
FSW 阴道、肛门直肠和口咽感染的患病率分别为 32.0%（95%CI 26.5%至 38.0%）、19.7%（95%CI 15.1%至 25.2%）和 3.2%（95%CI 1.6%至 6.2%），大多数阴道感染为 TV（23.4%；95%CI 18.5%至 29.2%）。所有 FSW 的 STI 患病率，在任何解剖部位均为 39.7%（95%CI 33.8%至 46.1%），其中 12.1%（95%CI 8.5%至 16.9%）仅在肛门直肠部位检测到感染。在所有 CT 和/或 NG 感染中，64.4%（95%CI 50.4%至 78.4%）仅在肛门直肠部位检测到。NSW 阴道和口咽的 STI 患病率分别为 5.6%（95%CI 3.4%至 9.2%）和 0.8%（95%CI 0.2%至 2.9%），大多数阴道感染为 MG（3.2%；95%CI 1.6%至 6.2%）。多变量分析显示，在妓院工作的 FSW 中，肛门直肠 STI 的危险因素包括阴道 CT、NG 或 MG（p<0.001）、阴道 TV（p=0.029）和“恋爱关系”（p=0.038）。
这些 FSW 中仅在肛门直肠部位检测到高比例的 CT 和 NG，表明如果仅提供生殖器检测，可能会错过重要的感染，如果不识别高危女性的外生殖器感染，可能会对全球 STI 估计产生潜在影响。
