Risk factors for sexually transmitted infections in women in rural Northeast Brazil.

BACKGROUND Sexually transmitted infections (STIs) are highly prevalent in northeast Brazil, but factors associated with the presence of an STI have rarely been studied systematically. METHODOLOGY We performed a population-based study to assess factors associated with STIs in women of reproductive age (12 to 49 years) in a rural setting in northeast Brazil. A total of 734 women were eligible; 592 (80.7%) had initiated sexual life and were included. Women were examined for the presence of an STI. Socio-economic variables, sexual history, and behaviour were assessed through a structured questionnaire. Laboratory testing included: polymerase chain reaction for human papillomavirus (HPV); ligase chain reaction for Chlamydia trachomatis and Neisseria gonorrhoeae; VDRL and FTA-ABS for Treponema pallidum; analysis of wet mounts, gram stain and Pap smears for Trichomonas vaginalis; and ELISA for HIV. RESULTS At least one STI was present in 112 (19.6%) of the women. In logistic regression analysis, a previous visit to a Pap smear clinic was protective against an STI (OR=0.26; IC 95%: 0.12-0.57). The following variables were independently associated with STIs: > or =3 partners in life (2.35; 1.32-4.17); first pregnancy < 16 years of age (2.28; 1.09-4.78); not knowing if partner had another partner (3.56; 1.09-11.62). CONCLUSIONS The protective and risk factors identified can guide the implementation of gender- and age-specific control programs in rural northeast Brazil. Offering a simple preventive measure (Pap smear collection), usually done by a nurse in this setting, may be a useful opportunity for diagnosis and treatment of curable STIs, without considerable additional costs.