title: Factors associated with sexually transmitted infection underreporting among female sex workers in China.
abstract: OBJECTIVE
  To examine the underreporting of sexually transmitted infections (STI) (i.e., no STI by self-report but have at least one STI through biological testing or clinical examination) and factors associated with underreporting among female sex workers (FSWs) in China.
  
  
  METHODS
  A total of 454 FSWs were recruited from entertainment establishments in a rural county of Guangxi, China. Participants completed a self-administered survey about their demographic and working characteristics, history of STI (past or current infections), sexual history and practices, and HIV/STI-related knowledge and perceptions; 411 of the sample were also tested for syphilis, Neisseria gonorrheae, Chlamydia, Trichomonas, and genital warts.
  
  
  RESULTS
  About 18% (79 of 411) of the sample reported a history of STI (past or current infections). Biological testing or clinical examination revealed at least one STI (acute STI) for 42% (171 of 411) of the sample. Only 9% (37 of 411) of FSWs with acute STI reported an STI through self-report, which resulted in 33% (134 of 411) of FSWs who were considered underreporting their STI. STI underreporting was independently associated with younger age (adjusted odds ratio [aOR] 0.87, 95% confidence interval [CI] 0.76-0.99), a shorter duration of commercial sex (aOR 0.97, 95% CI 0.94-0.99), poorer knowledge of STI (aOR 0.81, 95% CI 0.70-0.94), and less sexual risks (aOR 0.52, 95% CI 0.41-0.66).
  
  
  CONCLUSIONS
  Underreporting of STI was prevalent in FSWs, especially among women with perceived lower STI risks. The underreporting might be largely due to their perception of low risks for STI and unawareness of STI symptoms (including asymptomatic STIs). Future studies of FSWs should identify those new in commercial sex with lower STI awareness and perceived risks and encourage them to seek timely and appropriate testing and treatment.
authors.affiliation: Department of Social and Behavioral Health, Texas A&M Health Science Center, College Station, TX 77843, USA. yhong@srph.tamhsc.edu
authors.forename: Yan
authors.initials: Y
authors.lastname: Hong
authors.forename: Xiaoyi
authors.initials: X
authors.lastname: Fang
authors.forename: Yuejiao
authors.initials: Y
authors.lastname: Zhou
authors.forename: Ran
authors.initials: R
authors.lastname: Zhao
authors.forename: Xiaoming
authors.initials: X
authors.lastname: Li
mesh_terms: D000293:Adolescent; D000704:Analysis of Variance; D002681:China / Q000453:epidemiology; D004522:Educational Status; D005260:Female; D015658:HIV Infections / Q000453:epidemiology / Q000523:psychology; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D007182:Income / Q000706:statistics & numerical data; D007407:Interviews as Topic; D009790:Occupations / Q000706:statistics & numerical data; D016017:Odds Ratio; D010342:Patient Acceptance of Health Care / Q000208:ethnology / Q000523:psychology* / Q000706:statistics & numerical data; D012309:Risk-Taking; D012424:Rural Population / Q000706:statistics & numerical data; D057566:Self Report; D011477:Sex Work / Q000523:psychology* / Q000706:statistics & numerical data; D012747:Sexual Partners; D012749:Sexually Transmitted Diseases / Q000175:diagnosis* / Q000208:ethnology / Q000523:psychology; D012928:Social Desirability; D055815:Young Adult