The Swiss STAR trial – an evaluation of target groups for sexually transmitted infection screening in the sub-sample of women
OBJECTIVES 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 observati...
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| Format: | Article |
| Language: | English |
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SMW supporting association (Trägerverein Swiss Medical Weekly SMW)
2020-12-01
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| Series: | Swiss Medical Weekly |
| Subjects: | |
| Online Access: | https://www.smw.ch/index.php/smw/article/view/2928 |
| _version_ | 1797974917542576128 |
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| author | Pietro Vernazza Manuela Rasi Michael Ritzler Ferah Dost Milena Stoffel Karoline Aebi-Popp Christoph V. Hauser Cate Esson Katharina Lange Lorenz Risch Axel J. Schmidt |
| author_facet | Pietro Vernazza Manuela Rasi Michael Ritzler Ferah Dost Milena Stoffel Karoline Aebi-Popp Christoph V. Hauser Cate Esson Katharina Lange Lorenz Risch Axel J. Schmidt |
| author_sort | Pietro Vernazza |
| collection | DOAJ |
| description |
OBJECTIVES
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.
MATERIALS AND METHODS
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.
RESULTS
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).
CONCLUSION
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.
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| first_indexed | 2024-04-11T04:27:19Z |
| format | Article |
| id | doaj.art-a316c773f5664c10840f57e50a9bcde2 |
| institution | Directory Open Access Journal |
| issn | 1424-3997 |
| language | English |
| last_indexed | 2024-04-11T04:27:19Z |
| publishDate | 2020-12-01 |
| publisher | SMW supporting association (Trägerverein Swiss Medical Weekly SMW) |
| record_format | Article |
| series | Swiss Medical Weekly |
| spelling | doaj.art-a316c773f5664c10840f57e50a9bcde22022-12-29T16:02:06ZengSMW supporting association (Trägerverein Swiss Medical Weekly SMW)Swiss Medical Weekly1424-39972020-12-01150515310.4414/smw.2020.20393The Swiss STAR trial – an evaluation of target groups for sexually transmitted infection screening in the sub-sample of womenPietro Vernazza0Manuela Rasi1Michael Ritzler2Ferah Dost3Milena Stoffel4Karoline Aebi-Popp5Christoph V. Hauser6Cate Esson7Katharina Lange8Lorenz Risch9Axel J. Schmidt10Division of Infectious Diseases and Infection Control, Cantonal Hospital St. Gallen, SwitzerlandDivision of Infectious Diseases and Infection Control, Cantonal Hospital St. Gallen, Switzerlandlabormedizinisches zentrum Dr Risch AG, Buchs, SwitzerlandGynaecological consultation, Walk-in Clinic Kanonengasse, Städtische Gesundheitsdienste Zurich, SwitzerlandGynaecological consultation, Walk-in Clinic Kanonengasse, Städtische Gesundheitsdienste Zurich, SwitzerlandLadycheck, Aids-Hilfe beider Basel, Switzerland; Department of Infectious Diseases, Bern University Hospital, University of Bern, SwitzerlandDepartment of Infectious Diseases, Bern University Hospital, University of Bern, SwitzerlandPROFA – Consultations in Sexual Health, Renens, SwitzerlandLadycheck, Aids-Hilfe beider Basel, Switzerlandlabormedizinisches zentrum Dr Risch AG, Buchs, SwitzerlandDivision of Infectious Diseases and Infection Control, Cantonal Hospital St. Gallen, Switzerland; Communicable Diseases Division, Swiss Federal Office of Public Health, Bern, Switzerland OBJECTIVES 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. MATERIALS AND METHODS 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. RESULTS 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). CONCLUSION 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. https://www.smw.ch/index.php/smw/article/view/2928sexually transmitted diseaseshepatitis BHIVsexual behavioursex work |
| spellingShingle | Pietro Vernazza Manuela Rasi Michael Ritzler Ferah Dost Milena Stoffel Karoline Aebi-Popp Christoph V. Hauser Cate Esson Katharina Lange Lorenz Risch Axel J. Schmidt The Swiss STAR trial – an evaluation of target groups for sexually transmitted infection screening in the sub-sample of women Swiss Medical Weekly sexually transmitted diseases hepatitis B HIV sexual behaviour sex work |
| title | The Swiss STAR trial – an evaluation of target groups for sexually transmitted infection screening in the sub-sample of women |
| title_full | The Swiss STAR trial – an evaluation of target groups for sexually transmitted infection screening in the sub-sample of women |
| title_fullStr | The Swiss STAR trial – an evaluation of target groups for sexually transmitted infection screening in the sub-sample of women |
| title_full_unstemmed | The Swiss STAR trial – an evaluation of target groups for sexually transmitted infection screening in the sub-sample of women |
| title_short | The Swiss STAR trial – an evaluation of target groups for sexually transmitted infection screening in the sub-sample of women |
| title_sort | swiss star trial an evaluation of target groups for sexually transmitted infection screening in the sub sample of women |
| topic | sexually transmitted diseases hepatitis B HIV sexual behaviour sex work |
| url | https://www.smw.ch/index.php/smw/article/view/2928 |
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