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Risk of syphilis in STI clinic patients: a cross-sectional study of 11 500 cases in Guangxi, China
  1. Susan P Y Wong1,
  2. Yue-Ping Yin2,
  3. Xing Gao2,
  4. Wan-Hui Wei2,
  5. Mei-Qin Shi2,
  6. Pei-Yong Huang3,
  7. Hong Wang3,
  8. Qiang Chen2,
  9. MuSang Liu2,
  10. Joseph D Tucker4,
  11. Xiang-Sheng Chen2,
  12. Myron S Cohen5
  1. 1University of Pittsburgh School of Medicine, Pennsylvania, USA
  2. 2National Center for STD Control, Chinese Academy of Medical Sciences & Peking Union Medical College Institute of Dermatology, Nanjing, China
  3. 3Guangxi Institute of Dermatology, Nanjing, China
  4. 4University of California San Francisco School of Medicine, California, USA
  5. 5University of North Carolina at Chapel Hill, North Carolina, USA
  1. Correspondence to:
 Dr Xiang-Sheng Chen
 National Center for STD Control, 12 Jiangwangmiao Street, Nanjing 210042, China; chenxs{at}


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.

  • CSWs, commercial sex workers
  • GUD, genital ulcer disease
  • MSM, men who have sex with men
  • STI, sexually transmitted infection
  • TPPA, Treponema pallidum particle agglutination
  • TRUST, toludine red unheated serum test

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  • Competing interests: None.

  • MSC, XSC and YPY conceived, designed and coordinated the study; YPY, XG, WHW, MQS, HW, QC and PYH provided on-site training and coordinated data collection; SPYW, XG, MSL, and JDT organised data for analysis; SPYW, XSC and MSC analysed the data, interpreted the results and wrote the manuscript.

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