title: Syphilis and its correlates among heterosexual males attending sexually transmitted infection clinics - observation from a multicity cohort in Jiangsu Province, China.
abstract: OBJECTIVE
  To estimate the prevalence of HIV and syphilis, incidence of syphilis and to identify the correlates of syphilis infection among heterosexual male attendees of sexually transmitted infection (STI) clinics (MSC).
  
  
  METHODS
  A cohort study of one-year duration was conducted in Yangzhou and Changzhou cities in Jiangsu province of China. The baseline survey commenced in June 2009, recruited 1225 consenting adult MSCs (609 in Yangzhou and 617 in Changzhou) through STI-clinic based convenience sampling.
  
  
  RESULTS
  Baseline HIV and syphilis prevalence were 0.49% and 17.29% respectively. Syphilis incidence rate was 7.22 per 100 person-years (6.53 in Yangzhou and 7.76 in Changzhou) during the 6-month follow-up with retention fractions of 27.38% and 35.15% for Yangzhou and Changzhou respectively. Majority of the participants were middle-aged, high school educated, married, living with partners and non-migrants. Very few subjects reported recent and consistent condom-use with regular partners. Although considerable number of MSCs reported recent sexual exposure with female sex workers (FSW) and non-FSW casual partners, the proportion of reported condom use was very low during those exposures. In multivariate analyses higher age, having recent sex with FSWs and being HIV-positive were associated with higher syphilis sero-positivity while higher education was protective. In bivariate analyses, being married, divorced/widowed, official residency of the study cities and non-use of condom with regular partners predicted higher risk.
  
  
  CONCLUSIONS
  Considering the potential bridging role of MSCs between high and low-risk populations, effective intervention strategies among them targeting the correlates of syphilis infection are urgently called for in Jiangsu province of China.
authors.affiliation: Jiangsu Provincial Center for Disease Prevention and Control, Nanjing, China.
authors.forename: Xiao-Yan
authors.initials: XY
authors.lastname: Liu
authors.affiliation: Changzhou Center for Disease Prevention and Control, Nanjing, China.
authors.forename: Chao
authors.initials: C
authors.lastname: Hao
authors.affiliation: Yangzhou Center for Disease Prevention and Control, Nanjing, China.
authors.forename: Hui
authors.initials: H
authors.lastname: Jiang
authors.affiliation: Yangzhou Center for Disease Prevention and Control, Nanjing, China.
authors.forename: Lin
authors.initials: L
authors.lastname: Sun
authors.affiliation: Changzhou Center for Disease Prevention and Control, Nanjing, China.
authors.forename: Jian-Bo
authors.initials: JB
authors.lastname: Zhou
authors.affiliation: National Center for STDs Control, China CDC, Nanjing, China.
authors.forename: Yue-Ping
authors.initials: YP
authors.lastname: Yin
authors.affiliation: Department of Epidemiology, School of Public Health, University of California Los Angeles, Los Angeles, California, United States of America.
authors.forename: Weiming
authors.initials: W
authors.lastname: Tang
authors.affiliation: National Center for STDs Control, China CDC, Nanjing, China.
authors.forename: Ning
authors.initials: N
authors.lastname: Jiang
authors.affiliation: Department of Epidemiology, School of Public Health, University of California Los Angeles, Los Angeles, California, United States of America.
authors.forename: Tanmay
authors.initials: T
authors.lastname: Mahapatra
authors.affiliation: Department of Epidemiology, School of Public Health, University of California Los Angeles, Los Angeles, California, United States of America.
authors.forename: Sanchita
authors.initials: S
authors.lastname: Mahapatra
authors.affiliation: National Center for STDs Control, China CDC, Nanjing, China.
authors.forename: Xiang-Sheng
authors.initials: XS
authors.lastname: Chen
authors.affiliation: Jiangsu Provincial Center for Disease Prevention and Control, Nanjing, China.
authors.forename: Hai-Tao
authors.initials: HT
authors.lastname: Yang
authors.affiliation: Jiangsu Provincial Center for Disease Prevention and Control, Nanjing, China.
authors.forename: Geng-Feng
authors.initials: GF
authors.lastname: Fu
authors.affiliation: Jiangsu Provincial Center for Disease Prevention and Control, Nanjing, China.
authors.forename: Xi-Ping
authors.initials: XP
authors.lastname: Huan
mesh_terms: D000328:Adult; D000368:Aged; D002681:China / Q000453:epidemiology; D005260:Female; D005500:Follow-Up Studies; D015658:HIV Infections / Q000453:epidemiology / Q000635:transmission; D020010:Heterosexuality; D006801:Humans; D008297:Male; D008875:Middle Aged; D015995:Prevalence; D012307:Risk Factors; D013587:Syphilis / Q000453:epidemiology* / Q000635:transmission*
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