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Reference Id - Sts2024-3y-05755 2

This study aims to assess the prevalence of sexually transmitted infections (STIs) among commercial sex workers in Coastal Karnataka, focusing on high-risk populations. It will involve a cross-sectional methodology, utilizing surveys and questionnaires to gather data on demographics, sexual behavior, and STI prevalence. The findings are expected to highlight the challenges faced by sex workers and inform interventions to reduce STIs and improve health access.

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13 views6 pages

Reference Id - Sts2024-3y-05755 2

This study aims to assess the prevalence of sexually transmitted infections (STIs) among commercial sex workers in Coastal Karnataka, focusing on high-risk populations. It will involve a cross-sectional methodology, utilizing surveys and questionnaires to gather data on demographics, sexual behavior, and STI prevalence. The findings are expected to highlight the challenges faced by sex workers and inform interventions to reduce STIs and improve health access.

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REFERENCE ID:- STS2024-3Y-05755

TITLE:-
To study prevalence of sexually transmitted infections among commercial sex workers in tertiary
care centre of Costal Karnataka.

INTRODUCTION :-
A sexually transmitted infection (STI), also referred to as a sexually transmitted disease (STD) and
the older term venereal disease (VD), is an infection that is spread by sexual activity especially
vaginal inter course, oral sex ,anal sex or sometimes manual sex [1]. Sexually transmitted
infections (STIs) are one of the leading causes of health, and economic burdens in the developing
world, leading to considerable morbidity, mortality, and stigma [2].According to WHO, more than
thirty different bacteria, viruses, and parasites are transmitted sexually. Among them, eight are
selected as the prominent causal agent of sexually transmitted diseases. Between these eight, four
are curable viz. syphilis, gonorrhoea, chlamydia, and trichomoniasis.The other four are incurable
viz. hepatitis B, herpes simplex virus (HSV or herpes), HIV, and human papillomavirus (HPV)
[3,4]. The incidence and prevalence of the four curable STIs viz. syphilis, gonorrhoea, chlamydia,
and trichomoniasis vary remarkably across different geographical locations. In India, the
prevalence of four curable STI among general populations is in between 0 to 3.9 percent.
However, it is assumed that STI prevalence is much higher among subpopulations practicing
high-risk behaviour ranging from 20-30% ; like men who have sex with men (MSM), transgender
(TG), injecting drug users (IDU), and female sex workers (FSW) [2,9]. Studies indicate a high
incidence of infections such as HIV, HSV-2, syphilis, and chlamydia/gonorrhea among sex
workers in Karnataka[5].Factors influencing STI transmission include inconsistent condom use,
the socio-demographic background of sex workers, and instances of violence and harassment,
which deter access to health services and proper preventive measures[6]. In commercial sex
settings where condom use is inconsistent and access to effective STI treatment limited, half to
two-thirds of women working as sex workers typically have a curable STI at any one time. In some
settings, 10% or more have an active genital ulcer and over 30% reactive syphilis serology.
Gonorrhoea and chlamydia are often found in a one-third or more of sex workers. Such
transmission dynamics in commercial sex can sustain high STI incidence and prevalence in wider
sexual population[7,8].
The present protocol for cross sectional study of sexually transmitted infections among
commercial sex workers is to recognize the present prevalence and geographic
distribution of STIs among commercial sex workers and high risk Costal Karnataka.
OBJECTIVES:-
1. Prevalence of sexually transmitted infections (STI’s ) in tertiary care centre .
2. Reduce sexually transmitted infections and their complications and improve access to
quality sexually transmitted infection (STI) among commercial sex workers through educational
awareness and counselling.
3. Address the direct health risks and the broader social determinants that affect the health
of commercial sex workers in Costal Karnataka.

METHODOLOGY : -

Study Procedure : All patients (commercial sex workers)of sexually transmitted infections
visiting the STI clinics/out-reach clinic with clinical signs and symptoms of sexually transmitted
infections will be selected for the study through consecutive sampling if he/ she/they meet the
inclusion and exclusion criterions. Patient Education will be imparted at each site before the
initiation of data collection, outreach workers and peer educators will be oriented about the
study. During field visits, we will create awareness about the study and encouraged eligible
individuals to participate. All commercial sex workers attending the clinic for any reason (STI
symptoms, STI checkups, or other reasons) will be screened for eligibility criteria. There will be
a behavioural questionnaire pertaining to demographics, sexual behavior, condom use, treatment
seeking, and past exposure to STI prevention interventions. Written informed consent would be
taken from every eligible participant before conducting the study. Also, participants will be
informed of the nature and purpose of the study and only those who have given written consent
would be considered. Clearance from the Institutional Ethics Committee, written permission from
Dean and Director , Medical Superintendent, Head of Department of Dermatology, Venereology
and Leprosy (DVL), retrospective and prospective case records of sexually transmitted infections
(STD’s) among commercial sex workers will be taken before conducting the study.

Study Type: Institutional Based Cross sectional study.


Study Area: The study will be conducted in the STI clinics/outreach clinics who fits into inclusion
and exclusion criterions.
Data Collection: Each study participant would also be provided with a Patient Information Sheet
( Booklet ) containing information about the study project, methods of prevention and care of
affected members so as to create awareness among the public.

Sample Size:
Calculation of Sample Size (n):

n = Z2 ×p ×(1-p)
d2
Z = 1.96 ( Standard normal variate at 5% level of significance)
p = 14.1% or 0.141 (Proportion of sex workers with at least one active STI)
d = 5% or 0.05 (Allowable Error)

n= (1.96)2 × 0.141× (1-0.141)


(0.05)2
n = 186

Mode of Study: Surveys , Questionnaire Sessions , Seminars and camps, Hospital Sheet Records.
Sampling Techniques: Consecutive Sampling.
Ethical Clearance: Will be obtained.

Inclusion Criteria:

1. All patients (commercial sex workers) presenting to STI clinic/outreach clinics.


2. Those who are willing to participate in study.

Exclusion Criteria:
1. All cases without consent for sexually transmitted infections.
2. Pregnancy.

Statical Analysis :Collected data will be entered into a Microsoft Excel sheet and the data will be
analyzed using Microsoft Excel and the SPSS version .Categorical variables will be expressed as
frequencies and percentages. For continuous data, mean, standard deviation and range will be
calculated.

Confidentiality: Identity of any patient will not be revealed in any form at any stage of data
collection. The data will be used for the research and academic purpose only.

IMPLICATIONS :-
1. This study will provide different challenges and stigma faced by commercial sex workers .
2. This study will be able to differentiate between different types of sexually
transmitted infections among commercial sex workers .

3. It helps in early intervention to prevent complications of sexually transmitted infections


among commercial sex workers .
4. This study is required to view profile, pattern and changing trends of sexually transmitted
infections (STI’s) among commercial sex workers.
5. Lays foundation for further research on diseases manifestation and clinical management.

REFERENCES:-

1. Sexually transmitted infection (2024) Wikipedia. Available at:


https://en.wikipedia.org/wiki/Sexually_transmitted_infection (Accessed: 25 July 2024).
2. Mihir Bhatta, Majumdar A, Ghosh U, Ghosh P, Banerji P, Arumugam Elangovan, et al. Sexually
transmitted infections among key populations in India: A protocol for systematic review. PLOS
ONE. 2023 Jan 1;18(3):e0279048–8.
3. WHO. Sexually transmitted infections (STIs) [Internet]. Who.int. World Health Organization:
WHO; 2023. Available from: https://www.who.int/news-room/fact-sheets/detail/sexually-
transmitted-infections-(stis)
4. "Sexually transmitted infections (STIs) Fact sheet N°110". who.int. November 2013. Archived
from the original on 25 November 2014. Retrieved 30 November 2014.
5. Shaw SY, Deering KN, Reza-Paul S, Isac S, Ramesh BM, Washington R, et al. Prevalence
of HIV and sexually transmitted infections among clients of female sex workers in
Karnataka, India: a cross-sectional study. BMC Public Health. 2011;11(Suppl 6):S4.
6. Gurnani V, Beattie TS, Bhattacharjee P, Mohan H, Maddur S, Washington R, et al. An
integrated structural intervention to reduce vulnerability to HIV and sexually transmitted
infections among female sex workers in Karnataka state, south India. BMC Public Health.
2011 Oct 2;11(1).
7. Bradley J, Rajaram S, Alary M, Isac S, Washington R, Moses S, et al. Determinants of condom
breakage among female sex workers in Karnataka, India. BMC Public Health. 2011;11(Suppl
6):S14.
8. ‌Steen R, Dallabetta G. Sexually Transmitted Infection Control with Sex Workers: Regular
Screening and Presumptive Treatment Augment Efforts to Reduce Risk and Vulnerability.
Reproductive Health Matters. 2003 Jan;11(22):74–90.
9. Aggarwal P, Sonali Bhattar, Satyendra Kumar Sahani, Bhalla P, Garg VK. Sexually
transmitted infections and HIV in self reporting men who have sex with men: A two-year study
from India. 2016 Sep 1;9(5):564–70.
10. Shannon K, Goldenberg SM, Deering KN, Strathdee SA. HIV infection among female sex
workers in concentrated and high prevalence epidemics. Current Opinion in HIV and AIDS
[Internet]. 2014 Mar;9(2):174–82. Available from:
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4286412/
‌

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