The study aimed to determine the prevalence of sexually transmitted bacterial infections and risk behaviors among freelance female sex workers in Cebu City. 46 freelance sex workers were tested for syphilis, gonorrhea, and non-gonococcal infections. 2.2% tested positive for syphilis, 4.3% for gonorrhea, and 37% for non-gonococcal infections. A survey found the sex workers' risk behaviors were not considered risky, though their knowledge on infections was low. The study concluded infection rates were low among this group, but their knowledge could be improved to further reduce risk.

2. The study aimed to determine the prevalence of sexually transmitted
bacterial infection and sexual risk behaviours among freelance female sex
workers (FFSWs) in Cebu City utilizing a cross-sectional study and
descriptive correlational statistics method of determination.
The necessary data for the study mere obtained from the Gonorrhoea, Non-
gonococcal and Syphilis test results of randomly, selected freelance female
sex workers in Cebu City. The Cebu City Health Hygiene Department was
the place for the sample collection and testing conduction. T
The forty six (46) respondents were gave their consent first before answering
the related questionnaires and undergoing different tests. A Serum samples
and an endocervical swab from each respondents were used to obtain the
objective of the study. All the data were tabulated in a percentage
presentation.
ABSTRACT:

3. Out of forty six (46) respondents, one (2.2%) FFSW was reactive for
Syphilis and forty five (97.8%) were non-reactive; for gonorrhoea, two
(4.3%) tested positive and forty four (95.7%) were negative; for non-
gonococcal infection, seventeen (37%) were positive and twenty nine
(63%) were negative.
The general weighted mean of the level of sexual risk behaviour in terms
of habits was 1.42 which was interpreted as not risky and in terms of
knowledge was 36.5% which was interpreted as low.
Based on the results it has been concluded that the prevalence rate of
the sexually transmitted bacterial infections in Cebu City are low and
the result on the risk behaviours are not risky in terms of FFSW habits
but low in terms of knowledge which correlates in FFSWs in
educational attainment that entails a significant relationship between
them.

4. RATIONALE:
Control of sexually transmitted infections (STIs) is important for the
prevention of STI sequelae, such as pelvic inflammatory disease, ectopic
pregnancy, infertility and chronic abdominal pain (Donovan, 2004).
In addition, STIs fuel the HIV epidemic by increasing the risk of HIV
acquisition (Rottingen et al, 2001; Donovan, 2004) and by increasing HIV
infectiousness among those already infected with HIV (Cohen et al, 1997;
Rothenberg et al, 2000).
The quality of the data on STDs in the Philippines is problematic.
Most of the data are obtained from female commercial sex workers.

5. Private practitioners are
reluctant to report STDs to
the Department of Health.
Data are not reported
regularly and often are
inaccurate because the
wrong diagnosis has been
made. .
Many problems with the
data result from inadequate
training of doctors, nurses
and midwives and a lack of
equipment and reagents
for STD testing.
RATIONALE…

6. RATIONALE…
Furthermore, because the
social hygiene clinics do
not have the capability to
do syphilis testing, syphilis
is known to be under-
reported.
The chronicle of prostitution
extends to all ancient and modern
civilization, with every mores
adopting its own standpoints and
way of thinking.
Dated back several centuries, a
ritual found in written records
marked the first form of
prostitution as practiced in ancient
Mesopotamia
(Gerda Lerner, 1986).

7. Hence, it is often referred to as "one of the world's oldest
profession”.
A long way more courteous preference is the term “sex
worker”, in the view of the fact, why most sex worker
activists groups reject the word “prostitute” and since the
late 1970s have used it instead (Leigh, 1979).
The world of the sex workers mostly entrenched around
money, for it is the most public domain of humanity.

8. RATIONALE…
As the population of sex worker gets higher, it would account for an
increase in frequency rates of harmful STIs just as happening in the
real world, subsequently.
Sex work is an active disease vehicle for all sexually transmitted
infections (STIs), replacing STDs by many experts in public health.
STIs affect people from all walks of life.

9. RATIONALE…
It is estimated that a million people acquire STIs including Syphilis,
Gonorrhea and Chlamydial Genital Tract Infection every day
around the world. (WHO, 2012)
Syphilis is caused by Treponema pallidum and has often been
called “the great imitator”, because its signs and symptoms are
indistinguishable from other diseases (K. Holmes, et al., 1999).

10. Neisseria gonorrhoeae is the
causative agent of
gonorrhoea, a disease that
is usually transmitted by
direct sexual contact.
Nearly 700,000 cases of
Gonorrhea are reported
each year in the United
States. (Stanley, 2009).
Chlamydia is a common
cause of pelvic
inflammatory disease with
subsequent risk for
infertility.
The higher prevalence of
chlamydia observed amongst
female adolescents .
(WHO,2001)
RATIONALE…

11. It is in the researchers’ perspective
to opt for this study for the reason
that issues concerning public health
predicament, this research can be a
factor upon setting up solutions for
the health crisis.

12. The health departments,
non- government
organizations
and the health workers,
their focus is mainly on
the significance of
HIV/AIDS,
there have been little
emphasis on educational
efforts in prevention of
STIs.
RATIONALE…
It is primed as part of
the baseline course for
the awareness of the
sex workers, their
clients and the public,
as a whole.

13. In contemporaries where
social outlooks concerning
sex are more liberal than ever
before, it is necessary that we
have a thorough knowledge of
every side of it;
consequences of having
unprotected sex by
increasing condom usage
delaying the onset of sexual
intercourse among
youngsters
avoiding multiple sex
partners among
sexually actives
reducing needle
sharing behaviour
among Intravenous
drug users or the
IDU’s,
expanding the impact
on the awareness in
sexual behaviour and
the link between
Syphilis as co-factor
of HIV.
RATIONALE…

14. Hence, this study sought to determine
the Prevalence of Sexually Transmitted
Bacterial Infections among Freelance
Female Sex Workers in Cebu City

15. The study will be beneficial to the following people:
CCHD (Cebu City Health Department)
The study will serve as an additional aid in monitoring the
prevalence of sexually transmitted bacterial infections and sexual
risk behaviours among the hard to locate freelance female sex
workers and consequently to prevent the spread of these type of
infections.

16. The results of this study can be utilized by CCHD to develop
models for initiating and implementing effective advocacy
programs on STI prevention especially to those hard – to -
access freelance sex workers.
Moreover, it will be an instrument to redesign STI
prevention programs for sex workers to ensure that they are
rights-based, meet actual social and economic needs, and are
not narrowly focused on condom use alone.

17. Freelance Female Sex Workers
The study will contribute in signalling awareness of the
impact of sexually transmitted bacterial infections in the city,
that will pose direction as to what shall be taken for them to
have interest and be encouraged to undergo regular Hygiene
exam in CCHD in order to specifically minimize the cases of
Gonorrhoea, Syphilis and Chlamydial genital tract infections
thus enabling everyone to be prepared in protecting one’s
health by breaking the chains of infection associated with
STIs.

18. Clients of Freelance Female Sex Workers
The study will influence the clients of FFSWs to heighten
their understanding of the factors that have to be considered
in the transmission of sexually transmitted bacterial
infections and in so doing will develop awareness on the
threats of risky sexual behaviors and unsafe sex practices.

19. Health practitioners and workers
The study will provide further ignition to conduct deeper
and more intensive public health education programs,
promoting protected sex, teaching the extent of sexually
transmitted bacterial infections’ interrelations together with
their risks factors and to formulate solutions for their
programs sustainability.

20. Individuals
The study will serve as a precaution and cognizance for
those individuals who practiced unsafe sex and multiple
partners.
Having read this research, they will become knowledgeable
and cautious of doing such activities.
Hence, the study will serve as a campaign against not only
for Sexually Transmitted Bacterial Infections Gonorrhoea,
Syphilis and Chlamydial genital tract infections but also
with other STIs.

21. Medical Laboratory Science Future Researchers
The study will serve as a hand-in resource material
for similar research work to be conducted in the
future.
Overseeing the information, a knowledge will be
seized that would pave way on the unfolding
practice of Medical Laboratory Science especially in
the annals of Microbiology

22. The target group of the study
will be the freelance female sex
workers (FFSWs) selling sex on
the streets who will undergo STI
testing in CCHD.
STI testing will be limited on the
detection of the following
bacterial agents like Treponema
pallidum, Chlamydia trachomatis
and Neisseria gonorrhoeae .
Only the respondents
working in Cebu city will
be integrated in the study,
limiting the data
extrapolation to sex
workers falling unto this
category.
Face – to – face interviews
will be conducted and
questionnaires will be
given to the respondents
to assess the sexual risk
behaviours of the FFSWs
along with their
demographic data.
SCOPE AND
LIMITATION

23. The researchers will employ Syphilis RPR test which
is a non – treponemal flocculation test used to
detect reagin antibodies associated with Syphilis.
For the detection of both Gonorrhoea and
Chlamydial genital tract infection, Gram staining
will be used using endocervical specimens.

24. CCHD Medical Technologists will read and
evaluate the samples collected and
presumptive diagnoses will be confirmed by
Dr. Ilya A. Tac – an, city epidemiologist and
head of the HIV/AIDS Detection Unit
Cebu City Health Department.
Laboratory procedures that will be
employed in this study will be patterned
according to protocols of CCHD.

25. General Objective:
The study will seek to determine the
prevalence of sexually transmitted bacterial
infections and sexual risk behaviours among
freelance female sex workers (FFSWs) in Cebu City.

26. Specific Objectives:
Specifically, the study will aim to:
Determine the profile of the FFSWs in terms of:
Age
Civil status
Educational attainment
Length of experience as a sex worker
Place of origin
Determine the Proportion of STI on FFSWs :
Gonorrhoea
Chlamydial Genital tract infections
Syphilis

27. What is the level of Sexual Risk Behaviours among FFSWs in terms
of:
A. Habits
B. Knowledge
Determine the relationship between
A. Prevalence and profile
B. Risk Behaviour and Profile
C. Prevalence and Risk behaviour
Based on the findings, what recommendation be suggested to
lessen the risk?

28. PREVALENCE
This will refer to the proportion of freelance female sex workers
who will test positive and or reactive either with Treponema
pallidum, Chlamydia trachomatis and Neisseria gonorrhoeae
after conducting the study.
FREELANCE FEMALE SEX WORKERS (FFSWs)
This will refer to unregistered female sex workers independently
working as they sell sex on the streets who will undergo testing
for sexually transmitted bacterial infections that will be
conducted by the researchers with the help from CCHD
authorities.
.

29. SEXUALLY TRANSMITTED BACTERIAL INFECTIONS
This will refer to infections acquired during intimate
sexual contact from infected individuals to partners like
venereal Syphilis, Gonorrhoea and Chlamydial genital tract
infections specifically caused by bacterial agents like
Treponema pallidum, Neisseria gonorrhoeae and Chlamydia
trachomatis
SEXUAL RISK BEHAVIOURS
This will refer to any habits, practices, actions or
reactions of the FFSWs towards sex working and sexuality
that increases their chances and vulnerability to
experience a particular bacterial disease or infection.

30. CEBU CITY HEALTH DEPARTMENT (CCHD)
A government agency which focuses on the promotion of health,
prevention of disease occurence and control of the spread of
communicable diseases, it is situated at Gen. Maxilom Ext., Cebu City
which one of the two sources of information and also one of the
studys’ environment.
GOOD SHEPHERD WELCOME HOUSE (GSWH)
A non-governmental institution run by the Religious of the Good
Shepherd Sisters that serves particularly women and children who
have been marginalized and neglected by the society situated at
Mabini St., Cebu City which is one of the study’s environment.

31. Syphilis
Sexually transmitted infection (STI) caused by the
bacterium Treponema pallidum, family Spirochaetaceae.
It has often been called "the great imitator" because so
many of the signs and symptoms are indistinguishable from
those of other diseases (K. Holmes, et al., 1999).

32. Gonorrhoeae
Neisseria gonorrhoeae, a
gram negative bacteria
belonging to family
Neisseriaceae, is the
causative agent of
gonorrhoea, a disease that is
usually transmitted by direct
sexual contact.
All people tested positive for
Gonorrhea should be tested
for other STIs like Chlamydia,
Syphilis and HIV

33. CHLAMYDIAL GENITAL TRACT INFECTION
Chlamydia trachomatis, a
gram negative intracellular
that causes ocular and
chlamydial genital tract
infection in humans.
C. trachomatis is the
world’s leading cause of
preventable blindness.

34. The study focused on the prevalence of sexually transmitted
bacterial infections and sexual risk behaviours
among freelance female sex workers in Cebu City, thus a
cross-sectional study design was chosen and a descriptive
correlational statistics was used.
It provided summaries on the number of cases of sexually
transmitted bacterial infections along with the behavioural
data of the respondents.
Research Design

35. RESEARCH DESIGN…..
It provided summaries on the number of cases of
sexually transmitted bacterial infections along with the
behavioural data of the respondents.
The variables of interest were based and compared from
the STI data of Cebu City Health Department which
provided sufficient additional information for the study.

36. RESEARCH RESPONDENTS
The respondents of the research were the FFSWs who are selling
sex on the streets in Cebu City. At a fixed regular time the sex
workers were gathered at the Good Shepherd Welcome House,
and were sent to CCHD STD/AIDS Detection Unit for testing.
Consent from the respondent to participate in the research
was included since most of the sexual risk behaviours are
confidential in nature and more on the reason for human
ethical considerations.

37. RESEARCH RESPONDENTS…
Consent from the respondent to participate in the
research was included since most of the sexual risk
behaviours are confidential in nature and more on the
reason for human ethical considerations.
Respondents who were still minors (under 18 years
old), consent from the parents or guardians were
obtained. And, to determine the respondents, the
FFSWs were screened to identify those who will test
positive for STIs.

38. The study utilized a
questionnaire, formulated to
cover information regarding the
FFSWs demographic data and
sexual risk behaviours.
Respondents completed the
questionnaires and interviews in a
natural setting.
The questionnaire was originally
written in English and was
translated into the common
Cebuano dialect to accommodate
the majority of the respondents.

39. The consent was the basis for the researchers
to include the respondents to the study.

40. Gram staining was applied for the direct detection of
Neisseria gonorrhoea and Chlamydia trachomatis while
for Treponema pallidum reagin antibodies detection,
Syphilis RPR testing was performed.
The study used statistical tables and graphs to present the
results obtained.

41. Percentages were calculated by the simple
formula:
% = (f ÷ N) x 100
Where:
% = percentage
f = frequency (the number of positive samples)
N = total number of Sample
Data were analysed and statistical treatments
were performed by a statistician.

42. General Weighted Mean
Formula
-was utilized to arrive to an
average which was computed
by giving different weights to
some of the individual values.
The Sturges formula was used to find
the size of the class intervals for the
FFSWs’ ages.
As determined by size of class interval
(h) = range
1+3.322 log N
Frequency data were
analyzed by
Pearson’s Chi-Squared test.

43. RESEARCH WORKFLOW:

44. RESEARCH WORKFLOW

45. RESEARCH WORKFLOW

46. Communication with CCHD
The researchers asked permission from the head of Social Hygiene
Section in Cebu City Health Department in conducting the study and
to gather previous data necessary for the study, as with regards to the
prevalence of sexually transmitted bacterial infections in Cebu City.
Communication with the Good Shepherd Welcome House
In gathering the research respondents, the researchers sought the
help and guidance of the directress of Good Shepherd Welcome
House. Since this non – governmental organization is a known
refuge of the FFSWs wherein they’re not judged and condemned
with the social stigma of their work.

47. SAMPLING AND STUDY PROCEDURES
Prior to research investigation the researchers gathered data
regarding the total population of FFSWs in Cebu City at present.
At Cebu City Health Department STD/ AIDS Detection Unit a
total of 208 FFSWs were recorded while at a Non-governmental
organization that houses FFSWs known as the Good Shepherd
Welcome House-statistics showed that FFSWs are greater in
number, reaching up to 237 individuals.

48. A week after the invitation, the gathering was set. Consent
forms together with the questionnaires were given to those
who were present.
Those who will agree were sorted and were brought to a
private place in GSWH for the interview and answering of
the questionnaire.
Both the consent form and the questionnaire contained
the participant study codes and were signed by witnesses
and by the researchers doing the interview.

49. Behavioural data were collected during the
interview and questionnaire administration
and included information on demographics,
duration of sex work, condom use, visit to
CCHD STD/AIDS Detection Unit, History of
STI and the place of origin.

50. the FFSWs were transported to CCHD SHC
STD/AIDS Detection unit for blood and
endocervical swab specimen collection.

51. CCHD nurses performed genital examinations and
collection of endocervical swabs.
Right after, venipunctures (syringe method) were
done by the researchers for the serologic Syphilis
testing.

52. There was no set limit with regards with the minimum and
maximum age of the participants, this was done to include
very young FFSWs since information from this vulnerable
group was considered a matter of importance.
However, whenever minors were included in the study,
appropriate parents’ or guardians’ consent and assent from
the respondent were sought.

53. Serum samples were tested for Syphilis in CCHD SHC STD/AIDS
Detection Unit using the Rapid plasma Reagin (RPR) Card test
(Human Gessel shaft fur Biochemica and Diagnostica Germany)
as a screening test.
Laboratory procedures were patterned after that of CCHD’s
protocols. Smears from the endocervical area were stained using
Gram stain for the direct examination and detection of
Chlamydia trachomatis and Neisseria gonorrhoea.

54. The presence of >20 pus cells/OIO was a
presumptive evidence of Non Gonococcal
Infection while the presence of gram
negative diplococci inside PMNs was
presumptive of Gonorrhoea.

55. For every test result, a professional medical technologist was
engaged for validation of the latter.
All the data will be kept with utmost confidentiality
Confirmation of Gonorrhoea and Chlamydial genital tract infection
were done by Dr. Ilya A. Tac-an, Head of the STD/AIDS detection
unit, based on the presumptive evidences on gram stains as well as
those of the respondents (FFSWs) signs and symptoms.
Confirmatory testing for Syphilis were done also by CCHD, using TPHA
hemagglutination test which was no longer a concern of the study.

56. RESULTS:

64. Based on the results from the study, the researchers
have come to the following findings:
Out of forty six (46) respondents, one (2.2%) FFSWs
was reactive for Syphilis and forty five (97.8%) were
non-reactive; for gonorrhoea, two (4.3%) were
positive and forty four (95.7%) were negative; for
non-gonococcal infection, seventeen (37%) were
positive and twenty nine (63%) were negative.
The general weighted mean of the level of sexual risk
behaviour in terms of habits was 1.42 which was
interpreted as not risky and in terms of knowledge
was 36.5% which was interpreted as low.
SUMMARY OF FINDINGS:

65. Based on the result from the forty six
(46) FFSWs as the respondents of the
study and considering the different factors
that affect the results of the study, it has
been concluded that the prevalence rate of
the sexually transmitted bacterial
infections in Cebu City are low and the
result on the risk behaviour are not risky in
terms of FFSWs habits but low in terms of
FFWSs knowledge which correlates in
FFWSs educational attainment that entails
a significant relationship between them.
CONCLUSION:

66. The researcher would like to suggest the following
actions to be recommended in the future:
The researchers recommend to the incoming
researchers to study a larger population than
the previous study.
A study to be conducted different places aside
from Cebu City.
A study with different gender group aside from
FFSWs.
A study on other sexually transmitted bacterial
infections having the current trend with high
prevalence rate.
RECOMMENDATION: