Risk Factors For Incident Neisseria Gonorrhoeae In A Prospective Cohort Of Kenyan Female Sex Workers
W Harrison, T Kinyari, A Meier, R Brunham, R Nguti, N Mugo, C Cohen
africa, epidemiology, gonorrhoea, sex workers
W Harrison, T Kinyari, A Meier, R Brunham, R Nguti, N Mugo, C Cohen. Risk Factors For Incident Neisseria Gonorrhoeae In A Prospective Cohort Of Kenyan Female Sex Workers. The Internet Journal of Infectious Diseases. 2005 Volume 5 Number 2.
299 sex workers in Nairobi, Kenya were followed a median of 14 months (IQR: 6-24 months) until acquisition of GC infection or censoring. At the initial visit and subsequent visits every two months, cervical samples were collected for GC and CT testing by PCR. At baseline, 18 (6%) of the 299 women had prevalent GC infection. Thirty-one incident cases of GC were detected over 345 years of observation, giving an incidence of 9.0 GC infections per 100 women-years. After controlling for age, HIV-serostatus and significant univariate variables, incident CT infection (Adjusted (A)HR = 5.9, 95% CI 2.2-15.8), and clinical findings of cervicitis (AHR = 3.1, 95% CI 1.1-8.6) remained independent risk markers for incident GC. In addition, the temporality of the relationship between the pathogens suggests a possible direct role of CT increasing the risk of GC.
A 299 member closed longitudinal cohort of female sex workers was assembled as part of an STI epidemiology and immunobiology study8 in May 2000 at the Kariobangi Nairobi City Council Clinic in Nairobi, Kenya. The study protocol underwent ethical review and approval at the relevant institutions. At the initial visit women were counseled on the risks involved with their current occupation and encouraged to find another profession. The women were treated for any current bacterial STI, directed on harm reduction, and provided free condoms. To join the cohort, written informed consent was necessary as well as the collection of demographic characteristics and a clinical history. A general physical and pelvic examination were included at the initial visit. Cervical specimens acquired during examination were tested for
Each participant was asked to return to the clinic every two months for follow up. At each successive visit, clinical and behavioral histories were determined since the time of the previous visit. Women were examined for
Molecular detection of
Demographic and clinical characteristics were assessed at enrollment. Subjects were followed for a median of 14 months (IQR 6 – 24 months). Thirty participants were diagnosed with 31 GC infections over 345 women-years of observation giving an incidence of 9.0 infections per 100 women-years. Cox regression analysis was used to calculate hazard ratios (Table 1).
In multivariate analysis, incident
In a cohort of FSWs, incident infection with
Centralized social venues (bars) have been strongly associated with the acquisition of
Our study is not equipped to determine the order of pathogenic infection. However, distinct mechanisms enable
The high frequency of antibiotic use in the study population likely confounded the incidence of