title: Sustained high prevalence of viral hepatitis and sexually transmissible infections among female sex workers in China: a systematic review and meta-analysis.
abstract: BACKGROUND
  The 1980's economic boom has been associated with a rapid expansion of China's sex industry over the past three decades. Consequently, the spread of sexually transmitted infections (STIs) and hepatitis infections among female sex workers (FSW) has become an important public health issue in China. This study identifies prevalence and risks of hepatitis and STIs in Chinese FSWs.
  
  
  METHODS
  Four electronic databases were searched for Chinese and English language peer-reviewed studies conducted between 01/2000-12/2011 that reported prevalence of hepatitis and STIs (excluding HIV) among Chinese FSW. Following the PRISMA guidelines, meta-analysis was used to estimate pooled prevalence and 95% confidence intervals for each infection.
  
  
  RESULTS
  Three hundred and thirty nine articles (34 in English and 305 in Chinese) investigating 603,647 FSWs in 29 Chinese provinces were included in this review. Over the period 2000-2011, the seroprevalence of active hepatitis B and hepatitis C among FSW were 10.7% (7.3-15.5%) and 1.0% (0.7-1.3%), respectively. The most prevalent STI was human papillomavirus (HPV, 27.0% [10.1-55.1%]), followed by herpes simplex virus-2 (HSV-2, 15.8% [11.7-20.9%]), chlamydia (13.7% [12.1-15.4%]), gonorrhoea (6.1% [5.3-7.0%]), syphilis (5.2% [4.8-5.7%]), genital warts (3.3% [2.5-4.2%]) and Trichomonas vaginitis (2.1% [1.5-24.2%]). Disease burden of both hepatitis and STI among FSW were concentrated in South Central and Southwest China. In particular, chlamydia and syphilis demonstrated a significant declining trend during the studied period (P < 0.05). Compared with the general Chinese population, FSW had significantly higher prevalence of all STIs except Trichomonas vaginitis. Further, compared to the general FSW population, HIV-positive FSW had significantly higher prevalence of syphilis, chlamydia, HSV-2 and Trichomonas vaginitis.
  
  
  CONCLUSIONS
  Prevalence of hepatitis and STIs remained high and mostly stable among Chinese FSW over the period of 2000-2011. Targeted STI and hepatitis surveillance and interventions should be strengthened among Chinese FSWs, especially those who are HIV-positive.
authors.affiliation: School of Public Health and Preventive Medicine, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, VIC, Australia. ssu27@student.monash.edu.
authors.forename: Shu
authors.initials: S
authors.lastname: Su
authors.affiliation: Melbourne Sexual Health Centre, Alfred Health, Melbourne, Australia. echow@mshc.org.au.|Central Clinical School, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, VIC, Australia. echow@mshc.org.au.
authors.forename: Eric P F
authors.initials: EP
authors.lastname: Chow
authors.affiliation: The University of North Carolina Project-China, Guangzhou, China. kmuessig@med.unc.edu.|Department of Health Behaviour, Gillings School of Global Public Health at the University of North Carolina at Chapel Hill, Chapel Hill, USA. kmuessig@med.unc.edu.
authors.forename: Kathryn E
authors.initials: KE
authors.lastname: Muessig
authors.affiliation: The School of Sociology and Population Studies, Renmin University of China, Beijing, China. yuanlei3415@126.com.
authors.forename: Lei
authors.initials: L
authors.lastname: Yuan
authors.affiliation: The University of North Carolina Project-China, Guangzhou, China. jdtucker@med.unc.edu.|London School of Hygiene and Tropical Medicine, London, UK. jdtucker@med.unc.edu.
authors.forename: Joseph D
authors.initials: JD
authors.lastname: Tucker
authors.affiliation: China Food and Drug Administration Institute of Executive Development, Beijing, China. zzhenhan@gmail.com.|Research Center for Public Health, School of Medicine, Tsinghua University, Beijing, China. zzhenhan@gmail.com.
authors.forename: Xiaohu
authors.initials: X
authors.lastname: Zhang
authors.affiliation: The School of Sociology, Tsinghua University, Beijing, China. renjiehui08@gmail.com.
authors.forename: Jiehui
authors.initials: J
authors.lastname: Ren
authors.affiliation: Melbourne Sexual Health Centre, Alfred Health, Melbourne, Australia. CFairley@mshc.org.au.|Central Clinical School, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, VIC, Australia. CFairley@mshc.org.au.
authors.forename: Christopher K
authors.initials: CK
authors.lastname: Fairley
authors.affiliation: Melbourne Sexual Health Centre, Alfred Health, Melbourne, Australia. jingjun@tsinghua.edu.cn.|Research Center for Public Health, School of Medicine, Tsinghua University, Beijing, China. jingjun@tsinghua.edu.cn.
authors.forename: Jun
authors.initials: J
authors.lastname: Jing
authors.affiliation: School of Public Health and Preventive Medicine, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, VIC, Australia. lei.zhang1@monash.edu.|Melbourne Sexual Health Centre, Alfred Health, Melbourne, Australia. lei.zhang1@monash.edu.|Central Clinical School, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, VIC, Australia. lei.zhang1@monash.edu.|Research Center for Public Health, School of Medicine, Tsinghua University, Beijing, China. lei.zhang1@monash.edu.
authors.forename: Lei
authors.initials: L
authors.lastname: Zhang
mesh_terms: D000328:Adult; D002681:China / Q000453:epidemiology; D002690:Chlamydia Infections / Q000453:epidemiology; D005260:Female; D006069:Gonorrhea / Q000453:epidemiology; D006525:Hepatitis, Viral, Human / Q000453:epidemiology*; D006558:Herpes Genitalis / Q000453:epidemiology; D018258:Herpesvirus 2, Human; D006801:Humans; D008297:Male; D015995:Prevalence; D016036:Seroepidemiologic Studies; D060386:Sex Workers; D012749:Sexually Transmitted Diseases / Q000453:epidemiology*; D013587:Syphilis / Q000453:epidemiology; D014247:Trichomonas Vaginitis / Q000453:epidemiology