title: Risk of syphilis in STI clinic patients: a cross-sectional study of 11,500 cases in Guangxi, China.
abstract: 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.
authors.affiliation: National Center for STD Control, Nanjing, China.
authors.forename: Susan P Y
authors.initials: SP
authors.lastname: Wong
authors.forename: Yue-Ping
authors.initials: YP
authors.lastname: Yin
authors.forename: Xing
authors.initials: X
authors.lastname: Gao
authors.forename: Wan-Hui
authors.initials: WH
authors.lastname: Wei
authors.forename: Mei-Qin
authors.initials: MQ
authors.lastname: Shi
authors.forename: Pei-Yong
authors.initials: PY
authors.lastname: Huang
authors.forename: Hong
authors.initials: H
authors.lastname: Wang
authors.forename: Qiang
authors.initials: Q
authors.lastname: Chen
authors.forename: Musang
authors.initials: M
authors.lastname: Liu
authors.forename: Joseph D
authors.initials: JD
authors.lastname: Tucker
authors.forename: Xiang-Sheng
authors.initials: XS
authors.lastname: Chen
authors.forename: Myron S
authors.initials: MS
authors.lastname: Cohen
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000553:Ambulatory Care; D002681:China / Q000453:epidemiology; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D011247:Pregnancy; D012307:Risk Factors; D013587:Syphilis / Q000453:epidemiology*