The Sexual Risk Behavior and Gonococcal Infections of Female

Panpacific University
Mc Arthur Highway, San Vicente,Urdaneta City, Pangasinan

Tel Nos. +6375-5683030/ Telefax +6375-6325039
www.panpacificu.edu.ph
THE SEXUAL RISK BEHAVIOR

AND GONOCOCCAL
INFECTIONS OF FEMALE
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Chapter 1
ABSTRACT
The study determined the proportion of gonococcal infection among female sex
workers in Urdaneta City, as well as their sexual risk behaviors as a basis for an
information material on health on programs for female sex workers. It specifically
sought to find out the proportion and magnitude of the gonorrhea cases among
consisting female sex workers registered for routine examination in Urdaneta City
who served as respondents of the study. They were selected from among those who
seek routine assessment in social hygiene clinic. Also included are their hygienic
and contraceptive practices, socio-demographic profile and the association between
the proportion of gonorrhea among females with regards to their profiles and sexual
risk behaviors.
Respondents were interviewed using a questionnaire as the main tool for data
gathering. To determine the proportion of gonorrhea among female, those who
identified the antibiotics specifically prescribed for gonococcal infections served as
a basis. Data gathered were statistically treated with frequency counts, percentage,
proportions to determine the relationship of the variables under study. An
information material on health programs for female is proposed for adoption and
implementation.
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INTRODUCTION
Rationale
Despite the ability to cure reproductive tract infections, including sexually

transmitted infections, they continue worldwide to be a major public health
problem. Reproductive tract infections (STI) cause serious health, economic, and
social consequences. In recent years, studies have shown that persons with STI,
including gonorrhea have an increased risk of acquiring human immunodeficiency
virus (HIV).
Sexually transmitted infections (STIs), passed on from one person to another

during sexual intercourse, whether vaginal, and or anal. STIs are a major cause of
morbidity in the Philippines. The number of STI cases reported by Social Hygiene
Clinics in 1993-1997 ranged from 30,000 to 51,000. Studies have shown a high
prevalence of sexually transmitted infections among females with the prevalence
rate of selected infections reaching more than 40%. Gonococcal resistance to
penicillin, tetracycline and ciprofloxacin is high. Behavioral surveillance date
indicate high prevalence of risky sexual behaviors like multiple sex partners and
non-condom use among high risk group like sex workers. (National Epidemiology
Center, DOH 2004).
Gonorrhea remains one of the most common venereal diseases in developing

countries and a global health problem despite a sharp decline in its incidence in
developed countries during the last decade. The problem is compounded by the
development of resistance to antimicrobials in Neisseria gonorrhea, which is a result
of both wide dissemination of resistant clones and the emergence of strains with
novel resistance mechanisms. Periodic monitoring of the antimicrobial susceptibility
profile of N. gonorrhea strains prevalent in a high-risk group such as sex workers
provides essential clues regarding treatment options and emergence of drug
resistance. Sex workers sustain very high rates of transmission of sexually
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transmitted diseases, among them gonorrhea with multiple antibiotic resistance is

common. Gonococcal infection has been implicated in facilitating human
immunodeficiency virus (HIV) acquisition and transmission. This is probably due to
mucosal inflammation, which provides greater access for HIV than that provided by
normal tissue, and the release of virus particles in semen is significantly greater in
HIV-infected patients with gonorrhea than in patients without gonorrhea (Journal of
Clinical Microbiology Antimicrobial Susceptibility and Plasmid Content of N.
gonorrhea Isolated from CSW, 2008).
Several studies demonstrate that 30-80% of gonorrhea infection in women are

asymptomatic, and thus go unreported. Asymptomatic infection often lead to delays
in treatment and in turn increases the risk of adverse reproductive sequelae. The
major complication of gonococcal infection in women is tubal scarring and infertility.
The incidence of involuntary infertility is estimated at 15% after one attack of pelvic
inflammatory disease (PID) and approximately 50-80% after 3 attacks. The incidence
of unwanted pregnancy is increased from 7-fold to 10-fold in women with previous
salpingitis, with resultant increased fetal and maternal mortality rates. Failure to
diagnose PID can result in acute morbidity, including tubo ovarian absences,
endometritis, Fitz-Hugh and Curtis syndrome (perihepatitis) and other chronic
sequelae, (emedicine online,http:///www.yahoo.com,2009).
Prevention and control of STIs is a public health priority. In a low HIV

prevalence country like the Philippines, it is impressive that every effort is made to
monitor trends of STIs in order to direct activities aimed at reducing them to the
lowest levels possible.
Proper counseling and educating them on safer sex practices like proper and
consistent condom use, monogamous relationship and prompt and routine medical
consultation after unsafe exposure are the best tools to prevent it. This way, the risk
of a rapid increased in HIV prevalence and an AIDS epidemic is diminished given
the close inter-relationship between STIs and HIV transmission.
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Statement of the Problem
This study determined the proportion of gonorrhea infection among female sex
workers in Urdaneta City as well as their sexual risk behaviors and to come up with
an information material on health programs for female sex workers.
More specifically, it sought to answer the following sub-problems:
1. What is the demographic profile of the female sex workers in terms of:
i. Age
ii. Religion
iii. Residence
iv. Place of work
v. Highest educational attainment, and
vi. Civil status?
2. What is the extent of the female sex workers sexual risk behavior as to:
a. History of sexual intercourse,
b. Number of partners per year,
c. Number of new sex partner per year,
d. Use of condoms,
e. Frequency of use of condoms,
f. Reasons for not using condoms,
g. Use of other contraceptives,
h. History of having STDs,
i. Time of having STDs,
j. Use of antibiotics and frequency of intake, and
k. Dosage of antibiotics taken
3. Is there a significant correlation between the respondents profiles and their
sexual risk, behavior with the proportion of those who have gonococcal
infections?
4. What is the proportion of female sex workers having gonococcal infections?
5. Based on the findings, what information material on health programs for female
sex workers can be proposed to prevent future reproductive complications?
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Chapter 2
RESEARCH METHODOLOGY
This Chapter presents the method and procedure that will be used in the study.
It will specifically include the research design, the research location, the
respondents, the description of data-gathering instrument, administration of the
questionnaire and the statistical treatment of data.
Research Design
The study used descriptive cross-sectional survey design using the

questionnaire as the sole tool for data gathering.
Sources of Data
Locale of the Study
Urdaneta City, which is one of the three cities in Pangasinan is considered as a

major trading and commercial center with booming economy. Business
establishments like discos, night clubs, massage clinics and videoke bars which
employs Guest Relations Officers (GROs) announce who are collectively known as
female sex workers. Urdaneta City was chosen as the locale of the study because
majority of the female sex workers (FSW) in the Pangasinan are within this city.
Instrumentation and Data Collection
Participants answered the questionnaire adapted from that used by the

Department of Health, thus no need for instrument validation was necessary. The
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questionnaire was divided into two parts. Parts I gather the profile and Part II is
about the sexual risk behavior of the female. The following procedures were
observed in the conduct of data gathering:
Authorization to browse over confidential records of sex workers in social

hygiene government health facilities were secured from the chief of the social
hygiene clinics. Anecdotal data record sheets were prepared and bought to the
social hygiene clinic for recording potential names of respondents after approval by
the proper authorities was given. Floating of the questionnaires to the respondents
to ensure accuracy of response, followed by retrieval upon completion of filing up
the instrument. Data coding scheme was developed in preparation for analysis of the
data to be gathered. Data gathered were encoded in a statistical software for
analysis and later, interpretation of results.
Tools for Data Analysis
To determine the profiles, frequency counts and percentage were used:
Percentage:
%=-------------X 100
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100 – k
For quantative data, mean was computed as the measure of central tendency,
particularly for age, number of partners per year and number of new sex partners
per year:
Formula for mean:
__ ∑x
X=--------------
Where: __
X - mean
∑x – sum of all quantities/case/observations
N – number of observations/cases
The proportion of gonococcal infection is determined simply by dividing the

number of those with gonococcal infection based on the antibiotic treatment taken
divided by the number of respondents, and this shall be compared with the annual
proportion of gonococcal infections from 2005 to 2007.
To determine the correlation between the respondents profiles in the nominal
and ordinal levels of measurement, spearman rho coefficient of correlation was used
with the following formula without the assumption of normal or Gaussian distribution:
6(∑d²)
Fs = 1- -----------------
N(N²-1)
Where:
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rs = Spearman’s Rank Order Correlation coefficient
∑d² = the sum of squared differences between paired ranks
N = the number of paired observations
The correlation coefficient will be interpreted as follows:
-1.00 perfect negative correlation
-0.76- -0.99 very high negative correlation
-0.51- - 0.75 high positive correlation/association
-0.25 - - 0.50 moderately small correlation/association
-0.01 - - 0.24 very small negative correlation/association
0.00 no linear correlation
0.01 - + 0.24 very small positive correlation/association
+0.25 - + 0.50 moderately small correlation/association
+0.51 - + 0.75 high positive correlation/association
+0.76 - + 0.99 very high correlation/association
+1.00 perfect correlation/association
Statistical decisions to reject or to accept the null hypothesis was determined by

comparing the level of significance (a) previously set at 0.05 with the significance (p)
value, where rejection is implied when p ≤ a.
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PRESENTATION, ANALYSIS AND INTERPRETATION OF DATA
This chapter presents the data gathered with statistical treatment applied is
presented in graphical form for easier analysis and interpretation in attempt to give
answers to the following questions presented in this study.
PROFILES
Age
Table 1 represents the age distribution of the respondents. As the table shows,
majority of the respondents are aged between 18 and 23 (41 of 71, or 57.7%). Of
these, 10 are 23 years old, nine are 22 years old, seven are 20 years old, six are 21
years old and 19 years old and three are 18 years old.
The next group is the respondents group aged between 24 and 29 years, making
up roughly 32% of the total number of respondents. Of these, seven are aged 24
years old, five are 29 years old, four are 25 years old, three are 26 years old and
there are two each of respondents aged 27 and 28 years old. The last group of
respondents is aged between 30 and 36 years old making of the remaining seven
percent of the total number of respondents. Two of them are aged 30 years old, and
one each is aged from 31 to 36. This implies that the so called “marketability” of
these sex workers depend largely on their age, that is, they are more of what may be
called in-demand” if they are younger, thus explaining the age distribution biased
towards the younger age ranges. The mean age is 23.82.
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Table 1. Frequency distribution of female as to age group
Age Group Frequency Percent

18-23 41 57.7
24-29 23 32.3
30-36 7 11.0
TOTAL 71 100.0
Table 2. Frequency distribution of female as to highest educational attainment
Highest Frequency Percent Valid Percent

educational
attainment
Elementary 8 11.3 11.6
High school 54 76.1 78.3
College 7 9.9 10.1
Total 69 97.2 100.0
No response 2 2.8
TOTAL 71 100.0
Highest Educational Attainment
As seen on table 2 on educational attainment, majority of the respondents either

reached or finished high school, comprising 76% of the total number of respondents
(54 of 71) respondents. Eight finished or at least reached elementary school (11.3%),
and seven or approximately 10% reached or finished college. The level of education
is not only a determinant of success in life but more specifically a determinant of
what occupations can a person apply for. Two respondents (2.8%) failed to identify
their highest educational attainment.
The level of education becomes a critical factor in seeking employment and

particular, having slim chances of getting decent jobs. As already stated in the
preceding tables, it was apparent that majority of the respondents finished low level
of education.
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Table 3. Frequency distribution of female as to history sexual intercourse
History of Sexual Frequency Percent

Intercourse
None 4 5.6
Has History of 67 94.4
intercourse
Total 71 100.0
History of Sexual Intercourse
As expected, majority of the sex worker-respondents have a history of sexual

intercourse, as depicted by 94.4% positive response (67 of 71). Four of the
respondents (5.6%) reported that they have no sexual intercourse.
The researcher would have no means of verifying this response as to whether the
respondents were honest in their answer to this question or not since the aforesaid
may have felt shy in admitting the truth on their history of sexual intercourse.
Nonetheless, this researcher gave them the benefit of the doubt that they could
be telling the truth since a questionnaire was used and that he said instrument did
not require their names to be written for the purpose of anonymity and
confidentiality.
Table 4. Frequency distribution of female as to number of sex partner per year
Number of sex Frequency Percent Valid Percent

partners per year
1 23 32.4 33.3
2 27 38.0 39.1
3 or more 19 26.8 27.5
Total 69 97.2 100.0
No response 2 2.8
Total 71 100.0
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Number of partners per year
As shown on Table 4, majority of the respondents (27 of 70, or 38%) has two
partners on an annual basis, making up 38% of all the respondents, 23 respondents
admitted to have only one partner a year committing 32.4% of all of the respondents
of this study. Nineteen said they had at least three partners per year, or around 27%
of the total number of respondents.
The mean number of partners is approximately two per year (1.94). Two sex
workers failed or probably intentionally left this item blank (2.8%).
Table 5. Frequency distribution of female as to number of new sex partners per

year
Number of new Frequency Percent Valid Percent

partners per year
1 25 35.2 36.2
2 30 42.3 43.5
3 or more 14 19.7 20.3
Total 69 97.2 100.0
No response 2 2.8
Total 71 100.0
Number of new partners per year
As shown on Table 5. most of the respondents reported that they have two new
partners yearly (30 or 42.3%) while 25 or 35.2% of them said that they have one new
partner every year, 14 noted that they have three or more new partners yearly, or
roughly 20.3%. Two respondents failed to enumerate the number of new partners
yearly probably due to other to answer the question honestly. If is it be tallied
against the same respondents response on one the number of partners they have
had intercourse with on an annual basis then it could be deducted that most of the
respondents partners never come back.
The average number of new sex partners among the commercial sex workers is
approximately two or exactly 1.84 person per year.
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The implication of this data is great, in that one more the commercial sex workers
have new partners then the greater is the risk and the proportion of possibly
transmitting sexually transmitted diseases.
Table 6. Frequency distribution of female as to use of condoms during

Intercourse
Use of condom Frequency Percent

No 11 15.5
Yes 59 83.1
No response 1 1.4
Total 71 100.0
Use of condom
Based from the Table 6. Frequency most of the respondents reported that during
intercourse (59 of 71 or 83.1%) while other of respondents never use condom during
intercourse. One of the respondents either failed or intentionally did not answer the
question (1.4%).
This implies that majority of sex workers are aware of the importance of using
such contraceptive to prevent contracting sexually transmitted diseases. As to how
frequent do sex workers use condom during intercourse, this study asked the same
respondents and the results are presented on Table 7.
Table 7. Frequency distribution of female as to frequency of use of condoms

during intercourse
Frequency of use of Frequency Percent

condom
Sometimes 20 33.89
Often 14 23.72
Every sexual contact 25 42.37
Total 59 85.9
No response 12 14.1
Total 71 100.0
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Frequency of use of condom
The table on the preceding page shown that majority of the 59 respondents who
claim of using condom during intercourse use it every sexual contact (26 of 59 or
approximately 42.37%). 20 respondents said they use condoms sometimes (20 of 59
or 33%), and the remaining 14 said they use condoms often. Twelve of the
respondents deliberately did not answer the question. This implies that indeed the
sex workers are aware of the possible implications of their work. To determine the
reasons for not using the condoms every sexual contact, Table 8 is presented below,
also including those who claim to have never used condom.
Table 8. Frequency distribution of female as to reason for not using condom
Reasons for not using condom Frequency Percent Valid Percent

Cannot afford 4 5.6 7.5
Decreased 3 4.2 5.7
sensation/performance
Do not know how to use 1 1.4 1.9
Not available 2 2.8 3.8
Partners request 43 60.6 81.1
Total 53 74.6 100.0
No response 18 25.4
Reason for not using condom during intercourse
The most common reason among those respondents who did not use condom
every sexual contact is giving in to be their partners not to use one (43 or 53, or 81%
of those who responded) The far second is the issue on affordability (4 or 5.6% of
those who responded) followed closely by decrease in sensation or performance (3
or 5.7% of those who responded)
18 respondents did not answer the question, eight more than those who said they
do not use condom at all during sexual contact.
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A possible reason for not using condom is that sex workers may be aware of other
contraceptives that they can use.
Table 9. Presents the distribution of respondents according to use of contraceptives

other than condom.
Table 9. Frequency distribution of using other contraceptives
Contraceptive Frequency Percent Valid Percent

used other than
condoms used
Vaginal douche 16 22.5 23.9
Spermicide 1 1.4 1.5
Pills 27 38.0 40.3
Withdrawal 20 28.2 29.9
Vaginal douche 3 4.2 4.5
and pills
Total 67 94 100.0
No response 4 5.5
Total 71 100.0
Use of other contraceptives
Majority of the respondents use pills (27 of 67 or 40%), followed by those who
resort to the so-called “withdrawal”, vaginal douche (16 of 67 or 24%) and three
answered using both vaginal douche and pills (3 of 67, or 4.5%). One answered
using spermicide (1.5%). Seemingly, the respondents use hygienic or contraceptive
practices not to prevent acquiring sexually transmitted diseases (STDs) but to avoid
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pregnancy, since their responses are more of those that could prevent pregnancy
but not STDs. Four respondents (5.6%) did not answer the question.
Table 10. Frequency distribution of having history of STDs
History of STD Frequency Percent Valid Percent

None 35 49.3 50.7
Has had STD 34 47.9 49.3
Valid Total 69 97.2 100.0
No response 2 2.8
TOTAL 71 100.0
History of STDs
As shown on the table above there is almost equal distribution of respondents as

to the number of those with one without history of acquiring sexually transmitted
diseases. 34 out of 69 respondents (49.3) confirmed having been afflicted with STD,
and 35 of the 69 respondents or 50.7% said they had not been afflicted of any STDs.
Two (that is, 2 of 71 or 2.8%) reported not to have had any history of STD. Having
STD is innate among those actively engaged in unprotected sex, and among those
engaged in more than one partner. Although the researcher respects the responses
of the respondents, their responses may not be reflective of their true histories,
possible because of shame of admitting having sexually transmitted disease.
Table 11. Frequency distribution of respondents as to type or nature of STDs
Nature of STD Frequency Percent

Bacterial 38 53.53
Fungal 6 8.44
Both fungal and 3 4.22
bacterial
None 24 33.8
Total 71 100.0
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Types of Sexually Transmitted Diseases Contracted
In this question, the researcher had to sort and validate the responses with the
succeeding filter questions. Majority of the respondents categorically denied having
had any form of sexually transmitted disease by answering no in the preceding
question, but indicating the medication taken (antibiotic or antiviral) in the question
as medications they take. Thus the distribution of responses of the above table is
based on the safe and valid assumption that majority of the respondents has had
bacterial infections in their genitourinary tracts apparently because of active sexual
life (38 of 71, or 53%). Those with fungal infections number to six, most likely
candidiasis as this is the most common form of fungal infection of the reproductive
tract. Three either explicitly or implicitly had both bacterial and fungal infections of
the reproductive tract (4.22%).
Those who explicitly ticked no history of STDs in the part and did not identify any
medication fall under the category “none in the distribution above but does not
necessarily indicate no history of STD.
Table 12. Presents the time when the sexually transmitted disease was contracted
Table 12. Frequency distribution of respondents as to time of having been

afflicted with STDs
Time when STD was Frequency Percent

contracted
Within the year 3 4.22
No response 68 95.78
Total 71 100.0
Time when STD was contracted
The table above shows as only (4.22%) respondents survey was conducted.
Majority (68 of 71, or 96%) did not explicitly indicate the time of having been
afflicted with STD.
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Table 13. Frequency distribution of respondents as to frequency of STD

infection
Frequency of the Frequency Percent Valid Percent

infection
Once 2 2.8 25,0
Twice 6 8.5 75.0
Valid total 8 11.3 100.0
No response 63 88.7
TOTAL 71 100.0
Frequency of Infection
Despite of 47 respondents having admitted explicitly or implicitly their history of

having contracted STD, majority of the respondents (63 of 71 or 89%) did not reply
to the question on frequency of infection. Of these, 35 can be explained by the fact
that they denied earlier of having any history of STD based on their actual response
in the questionnaire, and two did not make any reply on the aforesaid question. This
means that only 8 of 47 or 17.02% of the respondents who had STD based on the
validated responses reported frequency of infection and the other 26 or 82.97% did
not of the eight who did, two (25% of those who responded) said they were infected
only one while six of three fourths of those who explicitly answered the
questionnaire have been infected twice. This may be construed as attributable to the
timidity of the respondents in admitting shameful reproductive conditions despite
the use of data-gathering instruments that minimizes the tendency of respondents
being identified owing to the low level of education among the majority of them, no
matter how the researchers would assure them of the confidentiality of the reporting
of their reproductive health status in this research. This shown on Table 12.
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Table 14. Frequency distribution of respondents as to use of antibiotics
Use of antibiotic Frequency Percent Valid Percent

treatment
No 24 33.8 35.3
Yes 44 62.0 64.7
Valid Total 68 95.8 100.0
No response 3 4.2
TOTAL 71 100.0
Use of antibiotic treatment
Table 14 shows that 68 respondents replied in the question on the use of

antibiotics. Of these, majority 44 of 68 or 65%) confirmed having taken antibiotics
purportedly for STDs, while 24 or 34% of those who answered this question did not
take antibiotics. Three respondents did not reply in this question. This is quite
normal, due to the fact that not all sexually transmitted diseases may be treatable
with some antibiotics if they are of bacterial origin, and some may not absolutely be
treatable by antibiotics, particularly if the pathogens are viral or fungal. Antibiotic
treatments are only meant for bacterial STDs but the sensitivity to this varies
according to the bacterial specimen causing the bacterial infection.
Furthermore, these findings can be constructed as an indication that the sex

workers have quite good familiarity with the use of antibiotics, implying that they
must have had examination when they were prescribed of some medications to take
for purposes if either or both treatment or prophylaxis. This also implies that the sex
workers contract bacterial infections more often than viral or fungal infections of the
reproductive tract. This distribution is shown on Table 11.
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Table 15. Frequency distribution of respondents as to number of antibiotics

taken
Number of Frequency Percent Valid Percent

antibiotics
1 17 38.63 73.91
2 5 11.36 21.74
3 or more 1 2.27 4.34
Valid Total 23 52.27 100.0
No response 21 47.72
TOTAL 44 100.0
Number of antibiotics
While there were 44 who confirmed to have taken antibiotics for STD treatment,
only 23 of them were able to determine the number of intake of antibiotics. 17 of 23
respondents of 74% of the total respondents who confirmed taking antibiotics (or
38.63% of those who identified the number of antibiotics taken) reported having
taken only one antibiotic. Five or 22% of respondents who reported numbers of
antibiotics, and only one respondent reported taking at least three antibiotics.
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CHAPTER 3
SUMMARY, CONCLUSIONS AND RECOMMENDATIONS
This chapter presents the summary of findings, the conclusions drawn and the
recommendations based on the findings of the study.
Summary
This study determined the profile of gonorrhea among female sex workers in
Urdaneta City, as well as their sexual risk behaviors and to come up with an
information material on health programs for female sex workers. It specifically
sought to find out the proportion and magnitude of gonorrhea cases among
consenting female sex workers registered for routine examination in Urdaneta City
who served as respondents of the study. They were selected from among those who
seek routing assessment in social hygiene clinics in government-owned health
institutions in Urdaneta City. Also in the data gathered are their hygienic and
contraceptive practices, socio-demographic profiles and the association between
the proportion of gonorrhea among female sex workers with regards to their profiles
and sexual risk behaviors.
The study is a survey among women working in different sex establishments. It

included consenting female sex workers registered for routine examination in social
hygiene clinic in Urdaneta City. From this number, a total of 71 female workers who
have different practices were taken as the final set of respondents. Respondents
were interviewed using a questionnaire as the main tool for data gathering. Cervical
smear results were also obtained as part of the documentary analysis to determine
the prevalence of gonorrhea among female sex workers. Data gathered were
statistically treated with frequency counts, percentages, proportions to describe the
data, and Spearman rank moment of correlation to determine the relationship of the
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variables under study. A proposed reproductive hygiene program is proposed

program is for adoption and implementation
Findings
Profiles
Age
Majority of the respondents are aged between 18 and 23 (43 of 71, or 57.7%). Of
these, 10 are 23 years old, nine are 22 years, seven are 20 years old, six are 21 years
old and 19 years old and three are 18 years old. Those aged between 24 and 29
years makes up roughly 32% of the total number of respondents. Of these, seven are
aged 24 years old, five are 29 years old, four are 25 years old, three are 26 years old
and there are two each of respondents aged 27 and 28 years old, making up the
remaining seven percent of the total number of respondents. Two of them are aged
30 years old, and one each is aged from 31 to 36.
The mean age is 23.82.
Residence
Majority of the respondents are from Nancayasan and PSU village and nearby
outskirts of Urdaneta City. Some of the respondents are from Binalonan (17, or 24%),
and the same reason as those from Urdaneta holds true. All the places of residence
in the table are known places where prostitution dens are found, with the exception
of one who originally hails from Surigao province (1.4%) and one from Misamis
Oriental, also in Mindanao (1.4%). Three are from places where no prostitution dens
are located (San Vicente, Urdaneta City), but are nonetheless within only a couple of
kilometers away from the red light districts of the city.
Religion
Most of the respondents are Roman Catholic, comprising almost 92% of the the
total number of respondents (65 of 71). Five are Jehovah’s witnesses, and one
belongs to the congregation of the Church of Jesus Christ and the latter Day Saints.
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Place of work
Majority of the respondents are working in prostitution dens in Urdaneta City,

mainly along Nancayasan leading to such populous districts as San Vicente East
area, and the new emerging prostitution places of Poblacion (7, or 9.8%) and in
Santa Barbara (1, 1.4%) 16 respondents work in Calasiao (22.5%).
Highest educational attainment
Majority of the respondents either reached, or finished high school, comprising

76% of the total number of respondents (54 of 71) respondents.
Eight finished or at least reached elementary school (11.3%), and seven or

approximately 10% reached or finished college.
Civil status
Majority of the respondents are single comprising 84.5% of the total 71

respondents of this study. Five are separated with their husbands (7%), three are
living in with their partners (approximately 3%) and two are married (around
4%).One of the respondents did not identify her civil status (1.4%).
Sexual practices
History of sexual intercourse
Majority of the sex workers-respondents have a history of sexual intercourse, as

depicted by 94.4% positive response (67 of 71). Four of the respondents (5.6%)
reported that they have no sexual intercourse.
Number of partners per year
Majority of the respondents (27 of 70, or 38%) has two partners on annual basis,
making up 38% of all the respondents. 23 respondents admitted to have only one
partner a year, comprising 32.4% of all the respondents of this study. 19 said they
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had at least three partners per year, or around 27% of the total number of
respondents.
The mean number of partners is approximately two per year (1.94). Two sex
workers failed or probably intentionally left this blank (2.8%).
Number of new partners per year
Most of the respondents reported that they have two new partners yearly (30 or
42.3%) while 25 or 35.2% of them said that they have one new partner every year 14
noted that they have three or more new partners yearly, or roughly 20%. Two
respondents failed to enumerate the number of new partners yearly, probably due
to shame or plain refusal to answer the question honestly.
The average number of new sex partners among the commercial sex workers is
approximately two, or exactly 1.84 persons per year.
Use of condom
Majority of the respondents use condom during intercourse (59 of 71 or 83%),

while less than 16% of the respondents never use condom during intercourse. One
of the respondents either failed or intentionally did not answer the question (1.4%).
Frequency of use of condom
Majority of the 59 respondents who claim using condom during intercourse use it
every sexual contact (26 of 61 or approximately 33%). 20 respondents said they use
condoms sometimes (20 of 61 or 33%), and the remaining 14 said they use condoms
often. Ten of the respondents deliberately did not answer the question. This implies
that indeed the sex workers are aware of the possible implications of their work.
Reason for not using condom during intercourse
The most common reason among those respondents who do not use condom
every sexual contact is giving in to their partner’s request not to use one (43 of 53, or
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81% of those who responded). The far second is the issue on affordability (4 or 5.6%
of those who responded), followed closely by decrease in sensation or performance
(3 or 5.7% of those who responded). 18 respondents did not answer the question,
eight more than those who said they do not use condom at all during sexual contact.
Use of contraceptives other than condom
Majority of the respondents use pills (27 of 67 or 40%), followed by those who
resort to the so called “withdrawal”, vaginal douche (16 of 67 or 24%) and three
answered using both vaginal douche and pills (3 of 67, or 4.5%). One answered
using spermicide (1.5%).
History of STDs
There is almost equal distribution of respondents as to the number of those with

and without history of acquiring sexually transmitted disease. 34 out of 69
respondents (49.3%), afflicted with STD, and 35 of the 69 respondents or 50.7%
afflicted of any STD. Two (that is, 2 of 71 or 2.8%) respondents have history of STD.
Having STD is innate among those actively engaged in the unprotected sex, and
among those engaged in more than one partner.
Type of Sexually Transmitted Diseases Contracted
Majority of the respondents categorically denied having had any form of sexually
transmitted diseases by answering no in the preceding question, but indicating the
medication taken (antibiotic or antiviral) in the question as a medications they take.
Thus, the distribution of responses of the above table is based on the safe and valid
assumption that majority of the respondents has had bacterial infections in their
genitourinary tracts apparently because of active sexual life (38 of 71, or 53%).
Those with fungal infections number to six, most likely candidiasis as this is the most
common form of fungal infection of the reproductive tract. Three either explicitly or
implicitly had both bacterial and fungal infections of the reproductive tract (4.22%).
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Time when STD was contracted
Only three (4.22%) respondents had the courage to admit of having STDs within
the year from the day that they was conducted. Majority (68 of 71, or 98%) did not
explicitly indicate them afflicted with STD.
Frequency of infection
Majority of the respondents (63 of 71 or 89%) did not reply to the question on
frequency of infection. Of these, 35 can be explained by the fact that they denied
earlier of having any history of STD based on their actual response in the
questionnaire, and two did not make any reply on the aforesaid question. This means
that only 8 of 47 or 17.02% of the respondents who had STD based on the validated
responses reported frequency of infection and the other 26 or 82.97% did not. Of the
eight who did, two (25% of those who responded) said they were infected only once,
while six of three fourths of those who explicitly answered the question (75%)
reported to have been infected twice.
Frequency of STD infection
Majority of the respondents claimed to have been infected with STD twice only.
Use of antibiotic treatment
Majority 44 of 68 or 65% confirmed having taken antibiotics purposely for STDs,

while 24 or 34% of those who answered this question did not take antibiotics. Three
respondents answered this question.
Use of antibiotics
Majority of the respondents use antibiotics for STDs contracted (62%) while only
24 or 34% do not take antibiotics.
Number of antibiotics
While there were 44 who confirmed to have taken antibiotics for STD treatment,
only 23 of them were able to determine or recall their number of intake of
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antibiotics. 17 of 23 respondents or 74% of the total respondents who confirmed

taking antibiotics (or 38.63% of those who identified the number of antibiotics taken)
reported having taken only one antibiotic. Five or 22% of respondents who reported
number of antibiotics taken took two antibiotics, and only one respondent reported
taking at least three antibiotics.
Description of antibiotic
Of the 44 who admitted taking antibiotics, majority of them (22 of 44 or 45%) are
taking doxycycline either the generic brands or branded ones. Amoxicillin is the
second most commonly taken antibiotic, but is known not to be effective for bacterial
infections of the reproductive tract, implying that those respondents taking this (13
of 44 or 30%) are self-medicating. Amoxicillin is effective for streptococcal bacteria
which uncommon to be causing diseases.
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Conclusions:
Based on the gathered results and findings of the study, the researcher has
arrived at the following conclusions:
1. Age, religion, residence, place of work and civil status were found to be not
significantly positively correlated with having gonococcal infection while
highest educational attainment was found to be significantly positively
correlated with having gonococcal infection.
2. As to sexual risk behavior, the number of sex partners per year, number of
new sex partners per year, use of condoms, frequency of use of condoms,
reasons for not using condoms, use of other contraceptives, history of having
STDs, time of having STDs and dosage of antibiotics taken do not significantly
influence the risk of contracting gonococcal infections.
3. History of sexual intercourse, use of antibiotics and frequency of antibiotic
intake significantly influence the risk of contracting gonococcal infections.
4. The proportion of female sex workers having gonococcal infection is
relatively high at 2.31.
5. An information affected on health for female sex workers can be proposed.
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Recommendations:
From the foregoing conclusion, the following recommendations are advocated:
1. That the government must provide alternative source of income for female sex
workers after a thorough social re-orientation so as to pull them from the risk
of contracting STDs, most dreadful of which is HIV/AIDS.
2. That a comprehensive reproductive health program be provided to female
sex workers so as to protect them from future complications of their work on
their health as well as to their partners.
3. Parallel studies must be conducted to a certain the effectiveness of the use of
alternative contraceptive devices in the prevention of disease transmission
affecting reproductive health.
4. Provision of continuing health education program on safer sex, monogamous
relationship as much as possible, proper and consistent condom use, prompt
and routine medical consultation after unsafe separate and distribution of
relevant printed material as distributed.
5. Development of health service package for female sex workers and other
vulnerable groups as well as implementation of a more intensive social
hygiene program.
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REVIEW OF THE LITERATURE AND STUDIES
This chapter deals with the review of literature and studies that have
relevance to the current study.
Related Literature
Gonorrhea is a sexually transmitted infection (STI) of epithelium and

commonly manifests as cervicitis, urethritis, proctitis, and conjunctivitis. If
untreated, infections at these sites can lead to local complications such as
endometritis, salpingitis, tuboovarian abscess, bartholinotis, peritonis, and
perihepatitis in female patients; periurethritis and epididymitis in male patients;
and ophthalmia neonatorum in newborns. Disseminated gonococcemia is an
uncommon event whose manifestations include skin lesions, tenosynovitis,
arthritis, and (in are cases) endocarditis or meningitis.
Microbiology. Neisseria gonorrhea is a gram-negative, non-motile, non-

spore-forming organism that grows singly and in pairs. Exclusively a human
pathogen, the gonococcous contains, on average, three genome copies per
coccal unit; this polyploidy permits a high level of antigenic variation and the
survival of the organism in its host.
Epidemiology. The incidence of gonorrhea has declined significantly in the

United States, but there were still 325,000 newly reported cases in 2006.
Gonorrhea remains a major public health problem worldwide, is a significant
cause of morbidity in developing countries, and may play a role in enhancing
transmission of HIV.
Gonorrhea predominantly affects young, nonwhite, unmarried, less educated

members of urban populations. The number of reported cases probably
represents half of the true number of cases- a discrepancy resulting from

underreporting, self-treatment and nonspecific treatment without a laboratory-
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proven diagnosis. The number of reported cases of gonorrhea in the United

States rose from 250,000 in the early 1960s to a high of 1.01 million in 1976. The
peak recorded incidence of gonorrhea in modern times was reported in 1975,
with 468 cases per 100,000 population in the United States. This peak was
attributable to the interaction of several variables, including improved accuracy
of diagnosis, changes in patterns of contraceptive use, and changes in sexual
behavior. The incidence of the disease has since gradually declined and is
currently estimated at 120 cases per 100,000 a figure that is still the highest
among industrialized countries. A further decline in the overall incidence of
gonorrhea in the United States over the past two decades may reflect increased
condom use resulting from public health efforts to curtail HIV transmission. At
present, the attack rate in the United States is the highest among 15 – 19 year old
women and 20 – 24 year old men; 40% of all reported cases occur in the
preceding two groups together. From the standpoint of ethnicity, rates are
highest among African Americans and lowest among persons of Asian or Pacific
Island descent.
The incidence of gonorrhea is higher in developing countries than in

industrialized nations. The exact incidence of any of the STIs is difficult to
ascertain in developing countries because of limited surveillance and variable
diagnostic criteria. Studies in Africa have clearly demonstrated that non-
ulcerative STIs such as gonorrhea are an independent risk factor for the
transmission of HIV.
Gonorrhea is transmitted from males to females more efficiently than in the

opposite direction. The rate of transmission to a woman during a single
unprotected sexual encounter with an infected man is 40 – 60 %. In any
population, there exists a small minority of individuals who have high rates of
new partner acquisition. These “core – group members” or high – frequency
transmitters” are vital in sustaining STI transmission at the population level.
Another instrumental factor in sustaining gonorrhea in the population is the large
number of infected individuals who are asymptomatic individuals, may not cease
sexual activity and therefore continue to transmit the infection. This situation
underscores the importance of contract tracing and empirical treatment of the
sex partners of index cases (Harrison’s Principles of Internal Medicine 17th
Edition, Vol. 1, 2008)
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BIBLIOGRAPHY
BOOKS
Calderon, Jose F .,et. Al., 1993 Methods of Research and Thesis Writing,
Philippine Copyright by National Book Store
Eileen Balley Compilation, 1992 Webster Contemporary Dictionary,

Illustrated Edition
Fauce, Anthony S., et.Al., 2008 Harrison’s Principle of Internal Medicine,

17th Edition
Philipine Pediatric Society Inc., 1992 Handbook on Infectious Diseases, 9th

Edition
Zinsser, Hens, 1988, Zinsser Microbiology, 19th Edition
Zulusta, Francisco M.,et. Al, 2003 Methods of Research Thesis Writing and
Applied Statistics, Philippine Copyright, by National Book Store.
33
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APPENDIX B
Questionnaire Form
i. Demographic Data
Name:
Patient No.
Age/Sex
Religion
Residence
Place of work:
Civil Status:
{ } single { } widowed
{ } live – in { } separated
{ } married
Educational Attainment:
{ } college
{ } high school
{ } elementary
ii. Sexual Risk Behavior
1. History of sexual intercourse?
{} yes {} no
If yes, number of partner/s per year?
{}1 {}2 { } more than 3
Number of new partner/s per year?
{}1 {}2 { } more than 3
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2. Use of condom?
{ } yes { } no
If yes, how often?
{ } every sexual contact { } sometimes
{ } often times { } rarely
3. Reason for not using condom

{ } can’t afford { } not available
{ } partner’s request { } decrease sensation/performance
{ } don’t know how to use
4. Other hygienic/contraceptives promotes of condom users?

{ } vaginal douche { } pills
{ } spermicide { } withdrawal
5. History of STD in the past?

{ } yes { } no
If yes, specify:
____________________
When?
(Year)______________
Frequency of infection?
{}1 { } 2x { } more than 3
6. Use of antibiotic treatment?

{ } yes { } no
If yes, how many?

{}1 { } 2x { } more than 3
Specify antibiotic used,____________________
35

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Panpacific University

Mc Arthur Highway, San Vicente,Urdaneta City, Pangasinan

THE SEXUAL RISK BEHAVIOR

Despite the ability to cure reproductive tract infections, including sexually

Sexually transmitted infections (STIs), passed on from one person to another

Gonorrhea remains one of the most common venereal diseases in developing

transmitted diseases, among them gonorrhea with multiple antibiotic resistance is

Several studies demonstrate that 30-80% of gonorrhea infection in women are

Prevention and control of STIs is a public health priority. In a low HIV

Statement of the Problem

More specifically, it sought to answer the following sub-problems:

The study used descriptive cross-sectional survey design using the

Locale of the Study

Urdaneta City, which is one of the three cities in Pangasinan is considered as a

Instrumentation and Data Collection

Participants answered the questionnaire adapted from that used by the

Authorization to browse over confidential records of sex workers in social

Tools for Data Analysis

To determine the profiles, frequency counts and percentage were used:

Formula for mean:

∑x – sum of all quantities/case/observations

The proportion of gonococcal infection is determined simply by dividing the

To determine the correlation between the respondents profiles in the nominal

rs = Spearman’s Rank Order Correlation coefficient

∑d² = the sum of squared differences between paired ranks

N = the number of paired observations

The correlation coefficient will be interpreted as follows:

-1.00 perfect negative correlation

-0.76- -0.99 very high negative correlation

-0.51- - 0.75 high positive correlation/association

-0.25 - - 0.50 moderately small correlation/association

-0.01 - - 0.24 very small negative correlation/association

0.00 no linear correlation

0.01 - + 0.24 very small positive correlation/association

+0.25 - + 0.50 moderately small correlation/association

+0.51 - + 0.75 high positive correlation/association

+0.76 - + 0.99 very high correlation/association

+1.00 perfect correlation/association

Statistical decisions to reject or to accept the null hypothesis was determined by

PRESENTATION, ANALYSIS AND INTERPRETATION OF DATA

Table 1. Frequency distribution of female as to age group

Age Group Frequency Percent

Table 2. Frequency distribution of female as to highest educational attainment

Highest Frequency Percent Valid Percent

Highest Educational Attainment

As seen on table 2 on educational attainment, majority of the respondents either

The level of education becomes a critical factor in seeking employment and

Table 3. Frequency distribution of female as to history sexual intercourse

History of Sexual Frequency Percent

History of Sexual Intercourse

As expected, majority of the sex worker-respondents have a history of sexual

Table 4. Frequency distribution of female as to number of sex partner per year

Number of sex Frequency Percent Valid Percent

Number of partners per year

Table 5. Frequency distribution of female as to number of new sex partners per

Number of new Frequency Percent Valid Percent

Number of new partners per year

Table 6. Frequency distribution of female as to use of condoms during

Use of condom Frequency Percent

Table 7. Frequency distribution of female as to frequency of use of condoms

Frequency of use of Frequency Percent

Frequency of use of condom

Table 8. Frequency distribution of female as to reason for not using condom

Reasons for not using condom Frequency Percent Valid Percent