Background: Gonorrhea (GC) poses a significant public health challenge worldwide. In Bangladesh, female sex workers (FSWs) are particularly susceptible to gonorrheal infections. This heightened rise is attributed to factors such as inconsistent condom use, limited access to health care, and NG among FSWs, which hinders effective surveillance and the implementation of tailored interventions. The study is therefore designed to determine the prevalence of NG and other STIs, and to pinpoint associated behavioral and socio-economic-demographic risk factors among FSWs in Rajshahi City of Bangladesh, and to assess the present status of the WHO’s target of a 90% reduction in NG incidence by 2030.
Methods: This cross-sectional study involved 430 FSWs in Rajshahi City, encompassing street-based, hotel-based, and residence-based individuals. The study period spanned January to June 2025, with participants selected using purposive sampling. Data collection involved in-person interviews using a semi-structured questionnaire supplemented by existing clinical and laboratory records. Statistical analyses, including descriptive and multivariate logistic regression, were employed. Lab technologists gathered samples from FSWs to examine urogenital health. Standard microscopic examination and syndromic management confirmed the presence of NG infections. Serological tests were employed to identify syphilis and chlamydia trachomatis.
Results: The study found that the average age of the FSWs was 30, with the majority in their mid-20s. Approximately 20.8% of the participants tested positive (urogenital NG infection). Furthermore, drug dependency showed a notable association with STIs positivity (p=0.01). Co-infections were prevalent, with chlamydia detected in 14.6% of cases, followed by syphilis 12.5%, hepatitis B & C combined in about 22% respectively. While HIV prevalence was lower overall, it was higher among FSWs whose partners were injecting drug users. The study highlighted societal challenges like poverty, limited education, unemployment, and experiences of violence, which exacerbated the risk of infection.
Conclusion: The high prevalence of GC among FSWs (younger age groups) showed the dynamics of sustaining GC transmission. This effectively means that Bangladesh has a long way to go to achieve the WHO’s target of a 90% reduction in NG incidence by 2030. To attain this goal, enhanced surveillance, screening, and comprehensive STIs services are needed for gonorrhea and co-infections.