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Background: Curable sexually transmitted infections (STIs) are a major global cause of female reproductive health morbidity. In Ecuador, there is little or no information on prevalence and risk factors for genital, anorectal and oropharyngeal STIs in atrisk women such as female sex workers (FSWs). Methods: A cross-sectional study was conducted among 250 FSWs and 250 non sex workers (NWSs) in north-west Ecuador between November 2018 and April 2019. Participants provided vulvo-vaginal (VVS), anorectal (only FSWs) and pharyngeal swabs and socio-demographic data. PCR was used to detect Chlamydia trachomatis (CT), Neisseria gonorrhoeae (NG), Mycoplasma genitalium (MG) from all swabs and Trichomonas vaginalis (TV) from VVS. Blood was collected for syphilis serology. Results: Overall prevalence of STIs in FSWs, at any anatomical site, vaginally, anorectally or in the oropharynx was, 39.7% (95% CI 33.4-45.4), 32.0% (95% CI 26.5-38.0), 19.7% (95%CI 15.1-25.2) and 3.2% (95%CI 1.6-6.2), respectively (See table 1). Isolated anorectal infection, that is without coinfection at other anatomical sites, of CT, NG or MG was 7.5% (95%CI: 4.8-11.6). Prevalence of positive syphilis serology (RPR/FTA ABS) was 2.4% (95% CI 1.1-5.1). In NSWs overall prevalence of having one or more STIs at any site was 5.6% (95%CI 3.4-9.2). Proportion of NSWs with at least one of CT, NG or MG in the vagina or oropharynx was 5.6% (95%CI 3.4-9.2) and 0.8% (95%CI 0.2-2.9), respectively and there were no cases of syphilis. Reported inconsistent condom use in FSWs with a stable partner and clients was 85.6% (95% CI 80.4-90.7) and 9.6% (95% CI 6.0-13.3), respectively. In NSWs, inconsistent condom use with a stable partner was 95.1% (95% CI 92.3-97.9). A high proportion of FSWs reported use of vaginal self-medication 87.2% (95% CI: 82.5-90.8). Conclusion: Overall prevalence of STIs in FSWs was high compared to NSWs, particularly for vaginal TV infection. FSWs also had a high proportion of isolated anorectal CT, NG, and MG, which calls for more research into extragenital infections, including a focus on barriers to condom negotiation. If replicated globally, findings may inform on STI prevention interventions. [ABSTRACT FROM AUTHOR]