Nouaman Marcellin N'zebo, Coffie Patrick Ahuatchi, Agoua Aline A, Zébago Clémence, Dao Hervé Z, Kissi Evelyne, Lenaud Severin, Anatole Mian, Becquet Valentine, Plazy Mélanie, Dabis François, Eholie Serge, Larmarange Joseph
Programme PAC-CI, Site ANRS Côte d'Ivoire, Abidjan, Côte d'Ivoire.
Département de Santé Publique et d'Odontologie Légale, UFR d'Odonto-Stomatologie, Université Félix Houphouët-Boigny, Abidjan, Côte d'Ivoire.
Front Public Health. 2025 Mar 12;13:1535122. doi: 10.3389/fpubh.2025.1535122. eCollection 2025.
Female sex workers (FSWs) are at high risk of contracting STIs, in particular in Sub-Saharan Africa. The implementation of oral HIV pre-exposure prophylaxis provided an opportunity to draw attention to the sexual health needs of FSWs. Innovative strategies to screen for and reduce the burden of STIs is thus a priority. This study describes STI screening among FSWs enrolled in the PRINCESSE project in Côte d'Ivoire.
The PRINCESSE project (2019-2023) was an interventional cohort of FSWs ≥18 years, evaluating a comprehensive, community-based sexual and reproductive health care package, including the management of STIs, offered through mobile clinics operating on prostitution sites in San Pedro area. HIV testing and syndromic STI testing were offered at baseline and every 3 months. Biological testing of (CT) and (NG) was offered annually. Clinical forms included sociodemographic, behavioral and sex-work-related characteristics. We describe baseline characteristics, coverage of clinical examination, and vaginal, anal swab collection. Social, behavioral and sex work-related factors associated with an STI syndromic diagnosis were explored. A multivariable logistic regression model was used to identify factors associated with diagnosing a symptomatic STI.
489 FSWs were included in the PRINCESSE cohort. Median age was 29 years (24-35 years), 28.6% had had sex without a condom in the last 7 days. The prevalence of HIV at baseline was 10.5%. Only one case of HIV seroconversion was observed during the project. The most frequent symptom was ano-vaginal discharge (19.1%). The prevalence of STI based on clinical symptoms was 26.6%. The proportion of vaginal swab samples for which the PCR result was positive was 8.0% for CT and 4.0% for NG. Only age remained significantly associated with diagnosing a symptomatic STI in the multivariable analysis.
This study revealed a high prevalence of HIV and STIs, similar to national estimates among FSWs enrolled in a sexual health cohort. Screening for these generically asymptomatic bacterial STIs must be combined with the syndromic approach used in key populations, especially with the introduction of new PrEP programs, to reduce the exposure of individuals in these populations to STIs.
女性性工作者（FSW）感染性传播感染（STI）的风险很高，尤其是在撒哈拉以南非洲地区。口服HIV暴露前预防措施的实施为关注FSW的性健康需求提供了契机。因此，创新的性传播感染筛查和减轻其负担的策略成为当务之急。本研究描述了参与科特迪瓦PRINCESSE项目的FSW中性传播感染的筛查情况。
PRINCESSE项目（2019 - 2023年）是一项针对年龄≥18岁的FSW的干预队列研究，评估通过在圣佩德罗地区卖淫场所运营的流动诊所提供的全面的、基于社区的性与生殖健康护理套餐，包括性传播感染的管理。在基线时以及每3个月提供HIV检测和性传播感染症状筛查。每年进行沙眼衣原体（CT）和淋病奈瑟菌（NG）的生物学检测。临床表格包括社会人口统计学、行为和与性工作相关的特征。我们描述了基线特征、临床检查的覆盖率以及阴道、肛门拭子采集情况。探讨了与性传播感染症状诊断相关的社会、行为和与性工作相关的因素。使用多变量逻辑回归模型来确定与有症状性传播感染诊断相关的因素。
489名FSW被纳入PRINCESSE队列。中位年龄为29岁（24 - 35岁），28.6%的人在过去7天内有无保护性行为。基线时HIV感染率为10.5%。在项目期间仅观察到1例HIV血清转化病例。最常见的症状是肛门阴道分泌物（19.1%）。基于临床症状的性传播感染患病率为26.6%。阴道拭子样本中CT的PCR结果阳性比例为8.0%，NG为4.0%。在多变量分析中，只有年龄与有症状性传播感染的诊断仍有显著关联。
本研究揭示了HIV和性传播感染的高患病率，与参与性健康队列研究的FSW中的全国估计值相似。对这些通常无症状的细菌性性传播感染的筛查必须与针对重点人群采用的症状筛查方法相结合，特别是在引入新的暴露前预防（PrEP）项目时，以减少这些人群中的个体感染性传播感染的风险。
