Prevalence of syphilis infection in different tiers of female sex workers in China: implications for surveillance and interventions

Abstract

BackgroundSyphilis has made a dramatic resurgence in China during the past two decades and become the third most prevalent notifiable infectious disease in China. Female sex workers (FSWs) have become one of key populations for the epidemic. In order to investigate syphilis infection among different tiers of FSWs, a cross-sectional study was conducted in 8 sites in China.MethodsSerum specimens (n = 7,118) were collected to test for syphilis and questionnaire interviews were conducted to obtain socio-demographic and behavioral information among FSWs recruited from different types of venues. FSWs were categorized into three tiers (high-, middle- and low-tier FSWs) based on the venues where they solicited clients. Serum specimens were screened with enzyme-linked immunosorbent assay (ELISA) for treponemal antibody followed by confirmation with non-treponemal toluidine red unheated serum test (TRUST) for positive ELISA specimens to determine syphilis infection. A logistic regression model was used to determine factors associated with syphilis infection.ResultsOverall syphilis prevalence was 5.0% (95%CI, 4.5-5.5%). Low-tier FSWs had the highest prevalence (9.7%; 95%CI, 8.3-11.1%), followed by middle-tier (4.3%; 95%CI, 3.6-5.0%, P < 0.001) and high-tier FSWs (2.2%; 95%CI, 1.6-2.9%, P < 0.001). Factors independently associated with syphilis infection included older age, lower education level, geographic location, lower tier of typology, and injection drug use.ConclusionsThis multi-site survey showed a high prevalence of syphilis infection among FSWs and substantial disparities in syphilis prevalence by the tier of FSWs. The difference in syphilis prevalence is substantial between different tiers of FSWs, with the highest rate among low-tier FSWs. Thus, current surveillance and intervention activities, which have low coverage in low-tier FSWs in China, should be further examined.

Vulnerabilities, health needs and predictors of high-risk sexual behaviour among female adolescent sex workers in Kunming, China

“…28 33–35 Nearly a third of participants had at least one STI, and particularly adolescents working at higher-risk venues were at increased risk, potentially due to the lower reported access to STI prevention and treatment services. Moreover, women who reported having accessed HCT services were less likely to report unprotected sex.…”

Dual Epidemics of Drug Use and Syphilis Among Chinese Female Sex Workers: Results of Eight Consecutive Cross-Sectional Surveys from 2006 to 2013 in Qingdao, China

“…The combination of using these new types of drugs and engaging in commercial sex could be a major potential driving force for the continued expansion of the HIV and other STDs epidemics in China. Few studies [6,17,18] found illicit drug use among Chinese FSWs presented a clear geographic pattern, with southeastern coastal cities most affected.…”

The Correlation between Educational Level and Incidence of Syphilis among Female Sex Workers within 7 Cities in Indonesia in 2007

“…FSWs are a source of infection and a population that connect the transmission of HIV and syphilis in heterosexuals, so that the data obtained in this study have an important impact in controlling STIs [6]. According to David L. Heymann, a sluggish clinical manifestation of syphilis needs an early detection, effective therapy with patients and theirs' contacts; thus, reducing transmission, preventing latent syphilis and preventing re-infection [7].…”