Background: Under the current global vision to control the HIV epidemic the through expanded provision of antiretroviral medications, relatively little attention has been devoted to sexually transmitted infections (STIs). Unfortunately, STIs remain a major cause of morbidity among people living with HIV, and STIs are associated with increased risk for HIV infection. This analysis assessed the burden of STIs among key populations (KPs), as well as prevalence of HIV among STI patients attending LINKAGES/Nepal-supported clinics.
Methods: LINKAGES/Nepal ? led by FHI 360 with support from the U.S. Agency for International Development and the U.S. President''s Emergency Plan for AIDS Relief ? provides HIV and STI diagnostic and case-management services to female sex workers (FSWs), clients of FSWs, men who have sex with men (MSM), male sex workers (MSWs), and transgender people in 16 districts of Nepal. The STI case-management services include counseling and syndromic management, syphilis screening using the rapid plasma reagin (RPR) test and treatment with benzathine penicillin, condom distribution to all KP members, and presumptive treatment of cervicitis for FSWs.
Results: From October 2016 to September 2017, 23,454 individuals (49 percent males, 50 percent females, and 1 percent trans people) were screened for STIs, of whom 5,475 (23 percent) were diagnosed with any STI. The most common diagnoses were vaginal discharge syndrome (69 percent) followed by syphilis (14 percent), urethral discharge syndrome (9 percent), and genital warts (4 percent). HIV prevalence among STI patients was 0.8 percent. HIV prevalence was highest among patients with syphilis at 3 percent; followed by patients with genital warts, at 2 percent; and vaginal discharge syndrome, at 0.4 percent. Out of 42 HIV-positive cases among STI patients, 21 (50 percent) had syphilis, 16 (38 percent) had vaginal discharge syndrome, 4 (10 percent) had genital warts, and one (2 percent) had urethral discharge syndrome.
Conclusions: The STI burden among KP program beneficiaries is high, and many HIV-positive KP members are co-infected with an STI. Providing integrated services helps to link a large number of KP individuals to needed STI services in this resource-limited setting.