Reports to the police for offences against sexual freedom in the Community of Madrid have increased significantly in recent years. In Spain, in 2019 there was an increase of 10.3% compared to the previous year (from 13,782 in 2018 to 15,319 in 2019)1.
The serious consequences to the victim's physical and mental health include sexually transmitted infections (STIs). Chlamydia trachomatis (CT) and Neisseria gonorrhoeae (NG) are the most frequently involved microorganisms and pertain to notifiable diseases. The latest data collected by the Red de Vigilancia Epidemiológica [Epidemiological Surveillance Network] (RVE) in Spain in 2019 report 17,718 and 12,359 cases of CT and NG, respectively2. Most STIs are asymptomatic and therefore their early detection is very important3.
This retrospective descriptive study sets out to determine the prevalence of STIs in women who reported sexual assault/abuse at the Hospital Universitario La Paz (HULP) in Madrid.
Baseline microbiological and forensic samples are collected whewn the assault is reported. Women≥12 years old were included from January 2018 to December 2020.
Variables analysed: age and microorganism.
The STI study was performed on endocervical swab, urine and serum. Endocervical swabs were plated on chocolate agar and VCA3 selective medium (bioMérieux). Urine samples were processed for the genomic identification of CT, NG, Trichomonas vaginalis (TV), and Mycoplasma genitalium (MG) in the BDMAX CT/NG/TV Becton Dickinson system up until 2019 and in the Allplex™ STI Essential Assay (Seegene®) system from 2020 onwards. The serological samples were processed for the diagnosis of hepatitis B and C viruses (HBV and HCV), human immunodeficiency virus (HIV) and syphilis with the Atellica®system, Siemens; confirmation of syphilis serology was performed by TP-PA, Serodia-TPPA® and RPR.
Of the 502 patients, a sample was obtained at the time of the emergency in 58.16% (292/502). Expressed in years: 59.53% (103/173) in 2018; 58.72% (101/172) in 2019 and 56% (88/157) in 2020.
Microbiological samples were not available for 15.53% (78/502) because the aggressor was the woman's partner and for 26.29% (132/502) a deferred sample was chosen and the patient did not attend the appointment.
An STI was detected in 11.6% (34/292) of the cases. 9.24% (27/292) corresponded to CT, 2.05% (6/292) to NG and 3 cases (1.02%) of CT/NG co-infection and 1 of them involved added infection with MG. 0.34% (1/292) were positive for TV, 0.34% (1/292) for syphilis, and 0.68% (2/292) for HBV; no positivity was detected in the serological control tests in the follow-up of HCV and HIV.
The most prevalent age range was from 15 to 27 years, with the mode of this group equal to 25 years and the second most frequent 18 years.
Comparing the prevalence of STIs in this study with that found in women in the HULP health district in the same period, the results are comparable: CT in 9.24% (27/292) and at HULP 8.9% (297/3334); NG 2.11% (6/292) vs. 2.35% (74/3265); syphilis 0.34% (1/292) vs. 0.001% (43/34,158); TV 0.34% (1/292) vs. 2.15% (71/3258); and GM 2.15% (71/3258) vs. 1.37% (9/587).
There are no Spanish publications with which to compare the results. Our prevalence is similar to other series of international publications4–7 (Table 1).
Results comparison.
| Location | Period | N | %CT | %GN | %TV | %MG | %Syphilis | %HIV | %HCV | %HBV |
|---|---|---|---|---|---|---|---|---|---|---|
| Norway | 2003−2010 | 412 | 6.4 | 0 | 0 | 1.9 | 0 | 0 | 0 | 0 |
| Amsterdam | 2005−2016 | 1066 | 10.3 | 1.8 | – | – | 0.1 | 0.2 | – | 0.6 |
| Korea | 2010−2019 | 1843 | 17.4 | 2.8 | 2.6 | – | 0.6 | 0 | 0 | 1.5 |
| Paris | 2012−2013 | 326 | 15 | 5 | – | 7.9 | – | – | – | – |
| Madrid | 2018−2020 | 292 | 9.24 | 2.05 | 0.34 | 0.34 | 0.34 | 0 | 0 | 0.68 |
Regarding transmission of the infection, in most cases we are not certain that the contagion occurred at the time of the assault5,7.
In the Spanish population, according to the RVE, most infections occur between 15 and 25 years2, in line with our result and with those reported in international studies5,6.
In conclusion, it is conceivable that the population most susceptible to suffering from an STI with particularly serious consequences, such as fertility problems, is the population under 25 years of age. Therefore, early detection and health education programmes should be designed for this population group.
Conflicts of interestThe authors who participated in this study declare that they have no conflicts of interest.
To the Gynaecology and Microbiology Departments and to the Research Ethics Committee of Hospital Universitario La Paz for having made this work possible, as well as to Dr. Menéndez for the preparation received, essential for continued research.
