Prevalence and risk factors of bacterial vaginosis among female Prevalence and risk factors of bacterial vaginosis among female sex workers in Surakarta

(1)

Journal of General - Procedural Dermatology & Venereology Journal of General - Procedural Dermatology & Venereology Indonesia

Indonesia

Volume 4

Number 1 Vol. 4, No. 1 (Dec 2019) Article 2

12-31-2019

Prevalence and risk factors of bacterial vaginosis among female Prevalence and risk factors of bacterial vaginosis among female sex workers in Surakarta

sex workers in Surakarta

Rini Hastuti

Department of Dermatovenerology Faculty of Medicine Universitas Sebelas Maret, Dr. Moewardi General Hospital, Surakarta

Danu Yuliarto

Agung Triana

Willa Damayanti

Rakhma Tri Irfanti

See next page for additional authors

Follow this and additional works at: https://scholarhub.ui.ac.id/jdvi

Part of the Dermatology Commons, Integumentary System Commons, and the Skin and Connective Tissue Diseases Commons

Recommended Citation Recommended Citation

Hastuti, Rini; Yuliarto, Danu; Triana, Agung; Damayanti, Willa; Irfanti, Rakhma Tri; Mardiana, Mardiana;

Dewi, Putti Fatiharani; Aliwardani, Ambar; Abas, Ervianti; Sulistyo, Sulistyo; Mawardi, Prasetyadi; and Ellistasari, Endra Yustin (2019) "Prevalence and risk factors of bacterial vaginosis among female sex workers in Surakarta," Journal of General - Procedural Dermatology & Venereology Indonesia: Vol. 4: No. 1, Article 2.

DOI: 10.19100/jdvi.v4i1.118

Available at: https://scholarhub.ui.ac.id/jdvi/vol4/iss1/2

This Article is brought to you for free and open access by UI Scholars Hub. It has been accepted for inclusion in Journal of General - Procedural Dermatology & Venereology Indonesia by an authorized editor of UI Scholars Hub.

(2)

Prevalence and risk factors of bacterial vaginosis among female sex workers in Prevalence and risk factors of bacterial vaginosis among female sex workers in Surakarta

Surakarta

Authors Authors

Rini Hastuti, Danu Yuliarto, Agung Triana, Willa Damayanti, Rakhma Tri Irfanti, Mardiana Mardiana, Putti Fatiharani Dewi, Ambar Aliwardani, Ervianti Abas, Sulistyo Sulistyo, Prasetyadi Mawardi, and Endra Yustin Ellistasari

This article is available in Journal of General - Procedural Dermatology & Venereology Indonesia:

https://scholarhub.ui.ac.id/jdvi/vol4/iss1/2

(3)

J Gen Proced Dermatol Venereol Indones. 2019;4(1):6-10 6 Original Article

Prevalence and risk factors of bacterial vaginosis among female sex workers in Surakarta

Rini Hastuti

¹

, Danu Yuliarto

¹

, Agung Triana

¹

, Willa Damayanti

¹

, Rakhma Tri Irfanti

¹

, Mardiana

¹

, Putti Fatiharani Dewi

¹

, Ambar Aliwardani

¹

, Ervianti Abas

²

, Sulistiyo

²

,

Prasetyadi Mawardi

¹

, Endra Yustin Ellistasari

¹

1. Department of Dermatovenerology Faculty of Medicine Universitas Sebelas Maret, Dr. Moewardi General Hospital, Surakarta

2. Department of Clinical Pathology Faculty of Medicine Universitas Sebelas Maret, Dr. Moewardi General Hospital, Surakarta

Email: [email protected]

Abstract

Background: Bacterial vaginosis (BV) is the most common vaginal infection in women of reproductive age and increases the risk of acquiring human immunodeficiency virus (HIV) and other sexually transmitted diseases (STDs). Data regarding the association between sexual activity and BV acquisition is contradictory.

Thus, tracking the prevalence and associated risk factors of BV among female sex workers (FSWs) is necessary to improve our understanding and control of STDs and the HIV epidemic.

Methods: The subjects of this study were FSWs in Surakarta. This study adopted a cross-sectional design, and diagnosis was established using Amsel criteria. Interviews were conducted using questionnaires to collect data of risk factors, including demographic factors (age, education level, daily income, marital status, location of sex), sociologic factors (age of first intercourse; age of first FSW encounter; duration of work as an FSW; number of clients/day; condom, contraceptive, and vaginal douching use; violence experienced as an FSW; smoking habits; alcohol consumption; and drug use), and knowledge factors (knowledge of STDs and HIV). Statistical analysis was performed by using bivariate analysis.

Results: We interviewed 175 FSWs with an average age of 40.66 years. BV was detected in 28 subjects (16%). Risk factors associated with BV include alcohol (p = 0.022) and drug use (p = 0.022).

Conclusion: Other than routine screening for STDs and HIV, FSWs should be encouraged to participate in prevention programs aiming to regulate alcohol and drug use to decrease the incidence of BV infection.

Keywords: bacterial vaginosis, female sex workers, risk factors

Background

The most common vaginal infection in women of reproductive age is bacterial vaginosis (BV), the prevalence of which varies from 9% to 50%;

however, the incidence of BV among female sex workers (FSWs) may reach 70%.¹

BV indicates a dysbiosis in which resident vaginal lactobacilli decrease in number; this condition is associated with the growth of anaerobic polymicrobial florae and is not considered a sexually transmitted disease (STD), which is usually described as a sexually enhanced disease

wherein the frequency of intercourse plays a critical role.²

BV can increase the risk of infection with human immunodeficiency virus (HIV) and other STDs, miscarriage, preterm labor, preterm delivery, postpartum complications, wound infections in pregnant women, and HIV viral shedding.³Several studies have described a number of risk factors associated with BV, such as higher number of sexual partners, younger age of first intercourse, employment as an FSW, regular douching, smoking, and recent unprotected sex.⁴

(4)

J Gen Proced Dermatol Venereol Indones. 2019;4(1):6-10 7 The aim of this study is to determine the

prevalence of BV and its associated risk factors among FSWs in Surakarta.

Material and methods

This study was approved by the Dr. Moewardi General Hospital Surakarta - Health Research Ethics Committee. The subjects of this study were FSWs in Surakarta, Central Java, Indonesia, who were enrolled through mobile clinics in collaboration with the Surakarta Health Office. This study adopted a cross-sectional design including a questionnaire and physical and laboratory examination. Written informed consent was provided, and subjects were asked to answer the questionnaire independently. Researchers provided assistance if a question was not understood by the subjects. The questionnaire included questions about risk factors, encompassing demographic, sociologic, and knowledge factors. Clinical examination and collection of specimens from the posterior fornix were conducted, followed by pH measurement

using litmus paper and Gram staining of the samples.

Diagnosis of BV was established on the basis of Amsel criteria, which include four clinical symptoms: 1) positive whiff test, 2) presence of thin, homogenous white/gray discharge; 3) pH >

4.5; and 4) > 20% clue cells. Univariate and bivariate analyses were conducted using SPSS.

Results

A total of 175 subjects were recruited into our study, and 28 subjects (16%) were diagnosed with BV. Demographic factors such as age, education level, daily income, marital status, and location of sexual activity were collected. A total of 71 subjects (40%) were aged 36−45 years, 57 subjects (32.5%) had the education level of elementary school, 83 subjects (47.5%) made less than 100,000 rupiah per day, 102 subjects (58%) were divorced, and 84 subjects participated in sexual activity in hotels (48%) (Table 1).

Table 1. Frequency Distribution of Demographic Factors Among Female Sex Workers

Frequency (n) %

Age (years) 17 – 25 26 – 35 36 – 45 46 – 55 55 – 65 > 65

15 39 71 33 15 2

8.5 22 40 19 8.5 2 Education level

Illiterate Elementary Junior high school Senior high school University

18 57 54 43 3

10 32.5

31 24.5

2 Income rate/day

< 100 thousands rupiah 100 – 500 thousands rupiah > 500 thousands rupiah

83 81 11

47.5 46 6,5 Marital status

Single Married Divorce

12 61 102

7 35 58 Location of sex

Street Hotel

Massage parlor Karaoke Others

51 84 51 7 6

29 48 29 4 3

(5)

J Gen Proced Dermatol Venereol Indones. 2019;4(1):6-10 8 Sociologic factors included age of first sexual

intercourse; age of first FSW encounter; duration of work as an FSW; number of clients/day;

condom, contraceptive, and vaginal douching use;

violence experienced as an FSW; smoking, alcohol consumption; and drug use (Table 2). A total of 62 subjects (61%) had the first sexual intercourse before the age of 20 years, 158 subjects (90%) became FSWs after the age of 20 years, and 88 subjects (50%) had been FSWs for < 5 years. A total of 79 subjects (45%) reported < 5 clients/day, 107 subjects (61%) reported no or infrequent condom use, 94 subjects (54%) reported using contraception, and 143 subjects (82%) reported

using vaginal douching. Most of the subjects (165;

94%) experienced no violence as an FSW, 111 subjects (63%) did not smoke, 145 subjects (83%) consumed alcoholic beverages, and 174 subjects (99.5%) reported drug use.

Knowledge factors were assessed regarding STIs and HIV infection. The majority of the subjects did not know about STIs (53%) but knew about HIV infection (62%) (Table 3). Bivariate analysis revealed that significant risk factors for BV were alcoholic beverages (p = 0.022) and drug use (p = 0.022).

Table 2. Frequency Distribution of Sociologic Factors Among Female Sex Workers (FSWs)

Frequency (n) % p

First-time sexual intercourse < 20 years old

≥ 20 years old 108

67

62 38

0.466 First-time being FSWs

< 20 years old

≥ 20 years old 17

158

10 90

0.373 Duration being FSWs

< 5 years 5 – 10 years > 10 years

88 59 26

50 35 15

0.951 Number of clients/day

< 5 5 – 10 > 10

79 57 39

45 33 22

0.978 Condom use

Yes No

68 107

39 61

1.000 Contraception use

Yes No

94 81

54 46

0.573 Vaginal douching

Yes No

143 32

82 18

0,968 Violence experienced during being FSWs

Yes No

10 165

6 94

0.722 Smoking

Yes No

64 111

37 63

0.267 Alcohol drinking

Yes No

30 145

17 83

0.022*

Drug use Yes No

1 174

0,5 99,5

0.022*

(6)

J Gen Proced Dermatol Venereol Indones. 2019;4(1):6-10 9 Table 3. Frequency Distribution of Knowledge Factors

Frequency (n) % p

Knowledge of STDs Yes

No

82 93

47 53

0.442 Knowing HIV infection

Yes No

109 66

62 38

0.636

Discussion

A study conducted by Guedou et al¹ showed that the prevalence of BV among FSWs was 47.6%

and that the associated risk factors included HIV infection, gonorrhea, trichomoniasis, candidosis, and hormonal contraception.⁵ Another study by Francis et al⁶ showed that the prevalence of BV among FSWs was 56% and that the associated risk factors included a younger age, higher number of sexual partners, current alcohol consumption, and other STDs, including HIV.⁶ In our study, the prevalence of BV was 16%, which is lower than that reported in previous studies.

Mascarenhas et al.² showed that the associated risk factors of BV were alcohol consumption and use of tobacco and illegal drugs. This study concluded that both risk factors should have been interpreted as indirect risk factors for BV, since the use of these substances was usually related to irregular condoms use and poor genital hygiene, that fostered the development of BV.² In the present study, the associated risk factors of BV included alcohol and drugs use, similar to the work of Mascarenhas et al.²

Drug use usually results in feeling of euphoria, alertness, increased in heart rate, respiratory rates, blood pressure, perception of confidence and physical strength, and appetite suppression.

Studies also suggest that drug use can increase libido, lower inhibitions, enhance sexual pleasure, delay orgasm, and prolong sexual intercourse. In particular, drug use is believed to have a disinhibiting effect on sexual decision-making and has been associated with unprotected sex and incidence of STDs, including HIV. Within this context, the need to increase the awareness of FSWs regarding the risks associated with drug use, including higher risk of HIV/STD infection associated with unprotected sex and potential tissue damage as a result of extended sexual activity, clearly exists.⁷ A study by Couture et al.⁸ showed high prevalence of drug use (14.8%−35.6%) among FSWs based on the location of the sexual encounter, thus suggesting

that drug use was associated with decision-making impairment and inconsistent condom use. FSWs may accept unprotected sex in exchange for money to satisfy their drug cravings. Clients seeking unprotected sex are also more likely to seek FSWs who use drugs or offer drugs to have unprotected sex.⁸A study in the USA showed that STDs are significantly more common in drug users with OR of 3.8.⁹

A study in South Africa showed that 30.6% of the subjects had consumed alcohol and that 19.2%

were current drinkers. Alcohol dependent women were twice as likely to report transactional sex than those who were not alcohol dependent. Indeed, binge drinkers were 3.1 times more likely to have had transactional sex than non-binge drinkers.

Alcohol use was associated with transactional sex, multiple sex partners, unprotected sex, inconsistent condom use, and violence.¹⁰

Conclusion

Prevention programs for FSWs should include routine screening for STDs and HIV. Alcohol consumption and drug use regulation could decrease the incidence of BV, other STDs, and HIV in FSWs.

References

1. Guedou FA, van Damme L, Deese J, et al.

Behavioural and medical predictors of bacterial vaginosis recurrence among female sex workers: Longitudinal analysis from a randomized controlled trial. BMC Infect Dis.

2013;13:1-11.

2. Mascarenhas REM, Machado MSC, da Costa e Silva BFB, et al. Prevalence and risk factors for bacterial vaginosis and other vulvovaginitis in a population of sexually active adolescents from Salvador, Bahia, Brazil. Infect Dis Obstet Gynecol. 2012:1-6.

3. Bitew A, Abebaw Y, Bekele D, Mihret A.

Prevalence of bacterial vaginosis and risk factors among woman complaining of genital tract infection. Int J Microbiol. 2017:1-8.

(7)

J Gen Proced Dermatol Venereol Indones. 2019;4(1):6-10 10 4. Bautista CT, Wurapa E, Sateren WB, Morris

S, Hollingsworth B, Sanchez JL. Bacterial vaginosis: A synthesis of the literature on etiology, prevalence, risk factors, and relationship with chlamydia and gonorrhea infections. Military Medical Research.

2016;4:1-10.

5. Guedou FA, van Damme L, Mirembe F, et al.

Intermediate vaginal flora and bacterial vaginosis are associated with the same factors: Findings from an exploratory analysis among female sex workers in Africa and India.

Sex Transm Infect. 2014;90:161–4.

6. Francis SC, Looker C, Vandepitte J , et al.

Bacterial vaginosis among women at high risk for HIV in Uganda: High rate of recurrent diagnosis despite treatment. Sex Transm Infect. 2016;92:142-8.

7. Dixon TC, Ngak S, Stein E, Carrico A, Page K, Maher L. Pharmacology, physiology and

perfomance: Occupational drug use and HIV risk among female sex entertainment and sex workers in Cambodia. Harm Reduction Journal. 2015;12:1–9.

8. Couture MC, Evans JL, Sothy NS, et al.

Correlates of amphetamine-type stimulants use and associations with HIV-related risks among young women engaged in sex work in Phnom Penh, Cambodia. Drug Alcohol Depend. 2012;120:119-26.

9. Salamanca SA, Sorrentino EE, Nosanchuk JD, Martinez LR. Impact of methamphetamine on infection and immunity. Frontiers in Neuroscience. 2015;8:1-12.

10. Magni S, Christofides N, Johnson S, Weiner R. Alcohol use and transactional sex among women in South Africa: Results from a Nationally Representative Survey. PLoS ONE.

2015:10(12):1-15.