Seroepidemiological study of gonorrhoea in Ethiopian women. 2. Socioeconomic picture.

Objectives: To determine aetiological factors associated with the prevalence of gonorrhoea in Ethiopian women to enable subsequent formulation of intervention policies.

Subjects: 1851 Ethiopian women: 50% symptomatic, 50% asymptomatic.

Setting: Gynaecological outpatient departments, antenatal, postnatal and family planning clinics (Ethiopian Family Guidance Association (EFGA)), in two teaching hospitals and a mother and child health centre in Addis Ababa, Ethiopia.

Methods: Using the indirect haemagglutination test with gonococcal pilus antigen, sera were tested for the presence of gonococcal antibodies indicating past or present infection. The socioeconomic facts were analysed against gonococcal seropositivity of these women.

Results: Gonococcal infection was associated with very early age at first marriage and first coitus, more than one sexual partner and marital status/profession. The highest prevalence and titres were found in bargirls (100%) prostitutes (89%) and sellers of local beer (85%). The lowest prevalence and titres were found in the highest income group, those married over the age of 18 years, those with only one husband or sexual partner, and those with a sexual life of less than 5 years duration.

Conclusions: National measures which could contribute to reduction and control of gonorrhoea include effective raising of the age of first marriage and first coitus, as has already been defined by law; the education of all girls up to fifth grade or equivalent; the provision of financial support to prevent widows and divorcees from drifting into prostitution; regular health checks and treatment of prostitutes; and education of men. While gonorrhoea per se is a major public health problem, our findings must have serious implications in the wider context of possible transmission of HIV through the community.