Risk of syphilis in STI clinic patients: a cross-sectional study of 11,500 cases in Guangxi, China.
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.
Wong
Susan P Y
SP
National Center for STD Control, Nanjing, China.
Yin
Yue-Ping
YP
Gao
Xing
X
Wei
Wan-Hui
WH
Shi
Mei-Qin
MQ
Huang
Pei-Yong
PY
Wang
Hong
H
Chen
Qiang
Q
Liu
Musang
M
Tucker
Joseph D
JD
Chen
Xiang-Sheng
XS
Cohen
Myron S
MS
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*