Sexually transmitted infections among female sex workers in Tunisia: high prevalence of Chlamydia trachomatis.

OBJECTIVES: The aim of this study was to determine the prevalence of Chlamydia trachomatis infection and other sexually transmitted infections (STI) in female sex workers (FSW) in Tunisia. METHODS: 188 prostitutes from three Tunisian towns were enrolled at their weekly medical visit. Demographic and sexual behaviour data were collected. C trachomatis, Neisseria gonorrhoeae, herpes simplex virus 2 (HSV-2) and human papillomavirus (HPV) were detected by PCR. Blood samples were tested for the presence of HIV, hepatitis B core, hepatitis C virus (HCV), HSV-2, C trachomatis and syphilis antibodies and Hbs antigen. RESULTS: The mean age of the FSW was 34 years. They had worked in the sex industry for 6.6 years on average. Nearly all FSW (98.9%) had at least one marker of STI. A current infection was found in 86.7% of cases. Only one STI was noted in 37.2% and two or more in 49.5% of FSW. C trachomatis, N gonorrhoeae, HPV and HSV-2 PCR were positive in 72.9%, 11.2%, 44.1% and 1.1% of cases, respectively. Syphilis, HCV antibodies and Hbs antigen were detected in poor percentages, 2.7%, 1.1% and 0.5% of cases, respectively. No case of HIV infection was noted. No epidemiological or clinical factors were associated with STI. Only disturbed bacterial vaginal flora was found to be associated with C trachomatis infection. CONCLUSION: In this study, a high rate of C trachomatis infection was observed. The detection of this microorganism should be introduced in systematic surveillance of Tunisian FSW.

Expanding medical abortion in Tunisia: women's experiences from a multi-site expansion study.

From November 2000 to July 2001, 321 consenting women were enrolled at four sites across the country in an effort to demonstrate that mifepristone medical abortion could safely be used by providers throughout Tunisia. Women who met the study's inclusion criteria were given 200 mg oral mifepristone and offered the choice of taking 400 microg oral misoprostol 2 days later either at home or at the clinic. At follow-up, women were examined to determine completed abortion status and surveyed to gauge their satisfaction with the method. Ninety-six percent of women had a successful abortion using this method. Women expressed a strong preference for home use of misoprostol, indicating that it is more confidential (34%), easier (28%) and requires fewer clinic visits (28%). The high rate of success, demonstrated safety and acceptability of the method in new facilities and with new providers suggests that medical abortion can be safely expanded to new settings with reasonable levels of training and supervision.

The medical abortion experiences of married and unmarried women in Tunis, Tunisia.

CONTEXT: The study explores the social dimensions of abortion in Tunisia and offers evidence supporting the provision of medical abortion to special populations, such as young and unmarried women. METHODS: For this study we recruited 222 women (unmarried: n = 101, married: n = 121) at three clinics in Tunis, Tunisia, from April 1999 to March 2001. All eligible women who consented to participate were administered a simplified regimen of medical abortion consisting of 200 mg oral mifepristone + 400 microg oral misoprostol 2 days later either at home or in the clinic. RESULTS: Our results demonstrate that unmarried women (94.8%) are as likely as married women (94.1%) to have a successful abortion using this regimen. We noted a strong initial preference for home administration of misoprostol among both groups (unmarried: 73.3%, married: 80.2%), which grew even stronger after the procedure. Women indicated that home administration is desirable because transportation to the clinic is expensive (32.7%), home administration is more confidential (26.3%), easier and more convenient (12.8%). Both groups expressed a high degree of satisfaction with the method. CONCLUSIONS: Medical abortion with the option of home administration of misoprostol is safe and feasible for special populations; such as unmarried women in Tunisia.

[Cervical cancer screening by Pap smear: experience of the National Research Center in Reproductive Health. ONFP]. / Depistage du cancer du col de l'uterus par frottis cervical: experience du centre national de recherche en sante de la reproduction. ONFP.

We have analysed the result of 17,173 pap smears screened in the national research center in reproductive health of Ariana from 1 may 1993 to 30 april 1997. Among these pap smears, 613 colposcopy and 380 biopsy have been performed. The results show that: 1.9% of pap smears present cytological anomalies with 0.79% of low Squamous Intraepithelial lesions and 0.66% high Squamous Intraepithelial lesions. The incidence of CIN III is 1.8% and 0.9% for invasive cancer. The age interval 35-44 years is at high risk of CIN III and invasive cancer of the cervix. evaluation of our diagnostic approach shows that: positive predictive value of pap smears with low SLI is 43.2% positive predictive value of pap smears with high SLI is 37.3%.