Commercial sex worker (CSW) has a high risk of experiencing sexually transmitted infections (STI) to clients. Sexually transmitted infection is still a health problem in developing countries because it has a major role in HIV transmission. An increase in STI cases often coincides with an increase in HIV cases, especially in high-risk populations, one of which is a female sex worker. Clinical manifestations of STI that occur among these populations are generally cervicitis, namely cervical inflammation that is often caused by infection with Neisseria gonorrhoeae or Chlamydia trachomatis. The main complaint of cervicitis is generally vaginal discharge or bleeding outside the menstrual cycle, but cervicitis can also not cause symptoms.

Diagnosis of STI apart from clinical also requires laboratory tests. However, in Indonesia, the laboratory infrastructure is not optimal, so the data collection on STI is more about the clinical syndromic approach. Therefore this study aims to describe the prevalence of STI in the form of nongonorrhea cervicitis and gonorrhea cervicitis, bacterial vaginosis, trichomoniasis vaginalis, and other STI in female CSW.

This study used medical record data from 100 female PSK patients who visited Primary Healthcare of Putat Jaya Surabaya in 2013-2014. The design of this study was a retrospective study. The data obtained from clinical examination, diagnosis, and therapy provided. The diagnosis of vaginal discharge was made by history taking, physical examination, vaginal and cervical smear.

Study Result

Out of 100 female prostitutes, 85 patients suffered from fluor albus, 1 patient suffered from genital vegetation, and 14 patients had no data. The most etiology of leucorrhoea is nongonorrhea cervicitis which affects 51 patients (51%), whereas gonorrhea cervicitis occupies second place suffered by 14 patients (14%), there are 10 patients (10%) who suffer from nongonorrhea cervicitis and bacterial vaginosis, then 9 patients suffer from vaginosis bacterial (9%), 1 patient had trichomoniasis vaginalis (1%). Patients are suffering from genital vegetation, namely condylomata acuminate by 1 patient (1%). Cervicitis mostly occurs in the young age group, due to higher activity, more sexual partners, less knowledge to prevent STI transmission, including negotiations to use condoms.

Therapy given to nongonoredan cervicitis and gonorrhea is given cefixime and azithromycin, to nongonore cervicitis accompanied by bacterial vaginosis given cefixime and azithromycin accompanied by metronidazole. As for bacterial vaginosis or trichomoniasis therapy using metronidazole. For genital vegetation (condyloma acuminate) can use podophyllin tincture medicine that is in the health center. The study also showed data on the duration of subjects being a CSW, mostly 1-5 years (52%), more than 5 years (31%) and less than 1 year (17%). Cervicitis is more common in CSWs who have been working for more than 12 months because of reduced immune susceptibility to cervicitis-causing bacteria such as Chlamydia trachomatis.

Clinical complaints and manifestations of fluor albus occurred in the majority of STD cases in this study. Nongonore cervicitis and nonspecific genital infection are the most common causes of fluor albus. Symptoms or complaints of vaginal discharge in high-risk women become markers of cervicitis caused by Neisseria gonorrhoeae and Chlamydia trachomatis. An approach through syndrome can be a strategy to reduce the risk of transmission. The program is aimed at reducing the prevalence and transmission of STI and HIV carried out at the Putat Jaya Primary Healthcare by providing dual therapy of 400 mg oral single-dose cefixime combined with azithromycin 1 g single oral dose for cases of gonorrhea and nongonorrhea cervicitis / nonspecific genital infections for female CSW.    

Author: Dr. Afif Nurul Hidayati dr., Sp.KK, FINS-DV, FAADV

Complete information from this research can be seen in our writing at:

https://www.pagepress.org/journals/index.php/dr/article/view/8050

Hidayati, A., Astindari, A., Sari, M., Murtiastutik, D., Martodihardjo, S., & Barakbah, J. (2019). Nongonococcal cervicitis: The most common cause of fluor albus in female sex workers. Dermatology Reports, 11(1s). https://doi.org/10.4081/dr.2019.8050