STI prevalence and associated factors among urban men in Pakistan

Objectives: To measure the prevalence of selected sexually transmitted infections (STIs) among urban men in Pakistan and identify associated factors. Methods: A cross-sectional survey of 2400 urban men aged 16-45 years was carried out in six cities of Pakistan. Respondents were selected through a multistage systematic sampling design. After obtaining informed consent a structured behavioural questionnaire was administered. Blood and urine samples were also collected and tested for HIV (ELISA), HSV-2 (ELISA) syphilis (RPR and TPHA), chlamydia (PCR) and gonorrhoea (PCR). Results: Of the 2383 respondents whose results were received, 4.4% (n=106) tested positive for at least one of the five STIs. The prevalence of the individual organisms was as follows: syphilis, 1.3%; HIV, 0.1%; HSV-2, 3.4%; gonorrhoea, 0.8% and chlamydia, no cases. City-wise, the highest prevalence was in Karachi (8.5%) followed by Lahore (5.3%), Faisalabad (4.0%) Quetta (4.3%), Rawalpindi (2.5%) and Peshawar (2.0%). At the univariate and multivariate level, older age, less schooling, and having more than four sexual partners were significantly associated with the presence of an STI. 92% of men who tested positive for any STI were asymptomatic. Conclusions: HIV prevalence in Pakistan remains low, however, the emergence of genital herpes is a matter of concern as it could lead to a future conduit for HIV spread. Health education messages should target less educated segments of society and specifically advocate safe sex practices and early diagnosis