Risk of syphilis in STI clinic patients: a cross-sectional study of 11 500 cases in Guangxi, China

• Published in: Sexually transmitted infections Vol. 83; no. 5; pp. 351 - 356
• Main Authors: Wong, Susan P Y, Yin, Yue-Ping, Gao, Xing, Wei, Wan-Hui, Shi, Mei-Qin, Huang, Pei-Yong, Wang, Hong, Chen, Qiang, Liu, MuSang, Tucker, Joseph D, Chen, Xiang-Sheng, Cohen, Myron S
• Format: Journal Article
• Language: English
• Published: London BMJ Publishing Group Ltd 01.08.2007; BMJ; BMJ Publishing Group LTD; BMJ Group
• Subjects: Addictive behaviors; Adolescent; Adult; Aged; Ambulatory Care; Bacterial diseases; Bacterial diseases of the genital system; Behavior; Biological and medical sciences; China - epidemiology; Cities; Clinics; commercial sex workers; Congenital diseases; Cross-Sectional Studies; CSWs; Dermatology; Disease; Disease prevention; Economic development; Education; Epidemiology. Vaccinations; Female; General aspects; genital ulcer disease; GUD; Health care; HIV; Hospitals; Human bacterial diseases; Human immunodeficiency virus; Human infectious diseases. Experimental studies and models; Humans; Infections; Infectious diseases; Laboratories; Male; Medical sciences; Medical tests; men who have sex with men; Middle Aged; MSM; Multivariate Analysis; Participation; Pregnancy; Prevention programs; Risk Factors; Sexually transmitted diseases; sexually transmitted infection; Statistical analysis; STD; STI; Studies; Substance abuse treatment; Surveillance; Syphilis; Syphilis - epidemiology; toludine red unheated serum test; TPPA; Treponema pallidum; Treponema pallidum particle agglutination; TRUST; Ulcers; Asia; China; Infection; Human; Sexually transmitted disease; Spirochaetosis; Cross sectional study; Syphilis; Risk factor; Bacteriosis; Risk; Treponematosis
• ISSN: 1368-4973; 1472-3263
• DOI: 10.1136/sti.2007.025015

Objective: To measure prevalence of syphilis among the STI clinic population in Guangxi, China, and to assess the socioeconomic and behavioural characteristics associated with the infection. Methods: We undertook a cross-sectional survey and syphilis and HIV serologic testing among 11 473 patients attending 14 community and hospital-based dermatovenereal clinics across eight cities in Guangxi between December 2004 and February 2006. Results: 1297 (11.9%) patients demonstrated positive toludine red unheated serum test and Treponema pallidum particle agglutination results with serologic testing. A total of 58% (752) of seropositive subjects presented with a genital ulcer, palmar/plantar rash or inguinal lymphadenopathy. Female sex (OR = 2.23, 95% confidence intervals (CI) = 1.69 to 3.00, p<0.001), less education (middle school, OR = 1.70, 95% CI = 1.11 to 2.62, p = 0.023; primary school or less, OR = 1.98, 95% CI = 1.13 to 3.46, p = 0.017) and high annual income (OR = 1.91, 95% CI = 1.18 to 3.10, p = 0.009 for >30 000 RMB yuan) were associated with serologically positive status. Syphilis infection was significantly more prevalent in city 2 (19.5%, OR = 3.07, 95% CI = 1.83 to 5.16, p<0.001), city 4 (16.6%, OR = 1.90, 95% CI = 1.10 to 3.28, p = 0.011) and city 8 (13.8%, OR = 1.83, 95% CI = 1.13 to 2.97, p = 0.006). A total of 40.1% (532) of infected subjects engaged in commercial sex and increased rates of the infection was associated with multiple sexual partners (OR = 1.54, 95% CI = 1.16 to 2.06, p = 0.003). A total of 1.2% (133) of participants carried laboratory markers for HIV and 1.8% (23) of patients with syphilis were positive for HIV. Conclusions: Syphilis infection has reached alarming rates in China’s STI clinic population, suggesting a generalised spread of the disease through commercial sex and bridging populations. Syphilis control is deserving of China’s highest priority. Universal screening for syphilis and HIV testing in STI clinics should be considered as measures for control.