Sex Work, Syphilis, and Seeking Treatment: An Opportunity for Intervention in HIV Prevention Programming in Karnataka, South India

The objective of the current study was to measure the determinants of syphilis among female sex workers (FSWs) in the state of Karnataka, South India.

In the context of a large-scale HIV prevention intervention, cross-sectional surveys were administered to 2,312 FSWs across five districts in Karnataka during 2004-2006. Surveyors obtained demographic and behavioral information, serum specimens (for syphilis, HSV-2 and HIV) and urine specimens (for Neisseria gonorrhoeae and Chlamydia trachomatis).

Prevalence of lifetime syphilis (TPHA positive) was 25.3 percent; prevalence of active syphilis (RPR and TPHA positive) was 9.6 percent. Among the districts, lifetime prevalence ranged from 10.9 percent to 37.4 percent; active prevalence ranged from 3.4 percent to 24.9 percent. Factors associated with lifetime syphilis were found to be older age, longer duration of sex work, illiteracy, client volume, practicing sex work in more than one city, and sex work typology (public solicitation followed by brothel or lodge-based sex). The same typology, client volume, illiteracy, and having been widowed, divorced or deserted were found to be predictive of active infection.

Among the women with symptoms of an STD (n=976), 78.8 percent had sought medical treatment, behavior that was protective for both outcomes. A strong association was found between HIV and lifetime (OR 2.0; 95 percent CI: 1.6-2.6) and active syphilis (OR 2.1; 95 percent CI: 1.5-2.9).

"Despite reasonable treatment-seeking behavior, the high prevalence of syphilis has necessitated enhanced outreach efforts for FSWs and acceleration of the implementation of syphilis screening," the authors concluded. "Mobilizing resources to enhance syphilis control will not only reduce the burden of syphilis morbidity, but should impact in reducing HIV transmission."

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