TY - JOUR AU - Vernazza, Pietro AU - Rasi, Manuela AU - Ritzler, Michael AU - Dost, Ferah AU - Stoffel, Milena AU - Aebi-Popp, Karoline AU - Hauser, Christoph V. AU - Esson, Cate AU - Lange, Katharina AU - Risch, Lorenz AU - Schmidt, Axel J. PY - 2020/12/31 Y2 - 2024/03/29 TI - The Swiss STAR trial – an evaluation of target groups for sexually transmitted infection screening in the sub-sample of women JF - Swiss Medical Weekly JA - Swiss Med Wkly VL - 150 IS - 5153 SE - Original article DO - 10.4414/smw.2020.20393 UR - https://smw.ch/index.php/smw/article/view/2928 SP - w20393 AB - <p><strong>OBJECTIVES</strong> <p>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.</p> <strong>MATERIALS AND METHODS</strong> <p>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 <em>Neisseria gonorrhoeae, Chlamydia trachomatis, Trichomonas vaginalis, Mycoplasma genitalium</em>) for pooled swabs (pharynx, urethra/vagina, anus), and antibody tests for human immunodeficiency virus (HIV) and <em>Treponema pallidum</em> at every visit, and for hepatitis B and C at baseline.</p> <strong>RESULTS</strong> <p>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 <em>T. pallidum </em>antibodies in 5.9% vs 0.0%. STIs requiring antibiotic treatment comprised: active syphilis 1.2% vs 0.0%; <em>N. gonorrhoeae</em> 4.9% vs 0.0%; <em>C. trachomatis</em> 6.3% vs 5.4%, <em>T. vaginalis</em> 10.4% vs 0.0%; <em>M. genitalium</em> 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 &lt;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).</p> <strong>CONCLUSION</strong> <p>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.</p></p> ER -