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Background Syphilis is a common sexually transmitted infection (STI) among men who have sex with men (MSM). Increasing syphilis testing is important to syphilis control. However, in low- and middle-income countries like China, syphilis testing rates remain low among MSM. We describe a randomized controlled trial protocol to examine the effectiveness of social network distribution approaches of syphilis self-testing among MSM in China. Methods We will recruit index and alter MSM. Indexes will be eligible if they: are born biologically male; aged 18 years or above; ever had sex with another man; are willing to distribute syphilis testing packages or referral links to their alters; and willing to provide personal contact information for future follow-up. Three hundred MSM will be recruited and randomly assigned in a 1:1:1 ratio into three arms: standard of care (control arm); standard syphilis self-testing (SST) delivery arm; and referral link SST delivery arm. Indexes will distribute SST packages or referral links to encourage alters to receive syphilis testing. All indexes will complete a baseline survey and a 3-month follow-up survey. Syphilis self-test results will be determined by photo verification via a digital platform. The primary outcome is the mean number of alters who returned verified syphilis testing results per index in each arm. Discussion The trial findings will provide practical implications in strengthening syphilis self-testing distribution and increasing syphilis testing uptake among MSM in China. This study also empowers MSM community in expanding syphilis testing by using their own social network.

Background Our previous study showed a recent increase in the incidence of African-type penicillinase-producing Neisseria gonorrhoeae (PPNG) in Guangdong, China. The aim of this study was to investigate the prevalence and molecular epidemiology of African plasmid in PPNG isolates in Guangdong in two time frames, 2013–2015 and 2018–2019. Methods A total of 864 isolates were collected in two cities in Guangdong. Minimum inhibitory concentrations (MICs) of seven antimicrobials were determined by the agar dilution method. The molecular epidemiological characteristics were determined by PPNG and tetracycline-resistant N. gonorrhoeae (TRNG) plasmids typing, Sanger sequencing of TEM β-lactamase (blaTEM) genes,NG_porB gene and N. gonorrhoeae multiantigen sequence typing (NG-MAST). Results Investigation by PCR showed that 31.02% (268/864) of the isolates were PPNG, of which 53.36% (143/268) contained the TRNG plasmid. The blaTEM genes of PPNG isolates were carried by African increased (18.42% to 66.67%), Asian decreased (81.58% to 28.89%), and Toronto/Rio increased (0 to 4%) plasmids. Further plasmid typing showed that PPNG isolates consisted of three major clusters, namely African plasmid/blaTEM-1 (128/268, 47.76%), Asian plasmid/blaTEM-135?(59/268, 22.01%), and Asian plasmid/blaTEM-1 (57/268,21.27%). The percentage of isolates with the blaTEM-1-carrying African plasmid as predominant plasmid increased significantly from 13.16%(5/38) in 2013 to 66.67%(60/90) in 2019. Among the isolates carrying the African plasmid possessing blaTEM-1, NG-MAST_sequence type (ST)5061, ST1927, ST17748 and NG_porB type 8, 13,11,12 were found to be the predominant STs in both periods, respectively, but which showed differences in two cities in two periods. Conclusions The proportion of African plasmid/blaTEM-1 PPNG has continuously increased since 2013, in association with clonal spread, which might contribute to the rising gonorrhoea epidemic in Guangdong. The possibility that African plasmid/blaTEM-1 was acquired requires careful follow-up and continuous monitoring of African plasmid/blaTEM-1 to ascertain whether it constitutes a step towards evolutionary change.

Background The sexually transmitted disease syphilis caused by Treponema pallidum subsp. pallidum (TPA), is resurging worldwide, particularly in developing countries. Nucleic acid amplification tests (NAATs) possess highly sensitive and specifical capabilities, which have been largely utilized for pathogen detection, e. g. virus, bacteria, and fungus. However, the traditional NAATs applied to diagnose TPA are insufficiently sensitive. Methods We established a novel PCR-CRISPR based syphilis molecular diagnosis with multiple excellent utilities. Results The new approach retains the advantage of the high specificity of NAATs and allows detecting TPA with low concentrations at the single molecular level, which is more sensitive than the classical PCR assay. We also adapt this method to analyze the TPA by Nichols-/SS14-like cluster genotyping and macrolide resistance-associated mutations detection in real-time, providing a powerful tool for improving syphilis surveillance and clinical decisions/treatment selections. We further applied these assays to evaluate a panel of 42 TPA strains circulating in Southern China and find that the prevalent TPA strains consist of 83.33% SS14- and 16.67% Nichols-like TPA strains, with 97.67% of strains harboring 23s rRNA mutations (A2058G or A2059G). Conclusion We developed a novel PCR-CRISPR-based syphilis molecular assay, which exhibits robust capabilities and prospects in the diagnosis and molecular epidemiology of TPA.

Background Under-screening of syphilis in clinical settings is a pervasive problem, especially in resource constrained settings where heavy patient loads and competing health priorities inhibit health providers’ ability to meet screening coverage targets. We piloted a “conditional pay-for-performance (P4P) strategy,” which rewarded providers at sexually transmitted disease (STD) clinics a monetary bonus for every confirmed case of syphilis they screened. By tying rewards to the number of cases detected, this strategy seeks to incentivize providers to concentrate their counseling efforts on indicated patients who need it the most. Methods Five STD clinics in a high syphilis transmission setting of China participated in the 6-month intervention. Data from the pre-intervention period was abstracted from clinic records. Multilevel logistic regression models with random intercepts to account for clustering within clinics were used to compare rates of syphilis case detection (number of confirmed positive cases over the total number of clinic attendees) in the 6-month periods prior to and during the intervention. Estimates were adjusted for age and sex of clinic attendees. Results A total of 7900 patients (49.0% male; 17.7% under the age of 25) sought care at one of the five STD clinics over the course of the study. Adjusted odds of a positive syphilis screen were greater during the intervention period compared to the pre-intervention interval (odds ratio, 1.33; 95% confidence interval, 1.14–1.56). Variability in clinic-level effects were substantial given the small number of sites of this pilot study. Conclusion Results of a conditional pay-for-performance pilot study demonstrate the feasibility and preliminary effectiveness of a conditional P4P strategy to improve syphilis case detection in Chinese clinical settings. Plans are underway for a fully powered randomized trial, findings from which could inform the utility of this approach for improving detection of common STDs in other resource constrained settings. Disclosure No significant relationships.

Background Female sex workers (FSW) are at high risk of gonorrhea and chlamydia infection. However, gonorrhea and chlamydia testing rate remain low in this population. This study aimed to assess the gonorrhea and chlamydia testing rates and its associated factors among FSW in Guangdong, China. Methods A cross-sectional study was conducted in seven cities in Guangdong province. We collected data on socio-demographic characteristics, gonorrhea and chlamydia testing uptake and health care services utilization from participants through face-to-face interview in 2017. We reported the outcomes adjusted for age, ethnic, education level, marital status, monthly income and local working time through multivariable logistic regressions. Results Overall, 1207 people participated in the survey. The mean age of FSW was 30.69±6.75 years. The average number of customers per week was 8.18±5.43. Ninety (7.46%) of them had gonorrhea testing and 125 (10.36%) people had chlamydia testing in the last 12 months. Multivariable analysis indicated that FSW who reported having abnormal vaginal discharge (aOR=3.33, 95%CI: 2.03–5.46) or having ulcers in the genital area (aOR=6.16,95%CI: 1.99–19.06) in the past year were more likely to have gonorrhea testing. Those who had stable partners (aOR=2.59, 95%CI: 135–4.99), had anal sex (aOR=2.23,95%CI: 1.76–2.84), had HIV testing (aOR=3.94,95%CI: 2.34–6.65) and syphilis testing (aOR=3.27,95%CI: 1.96–5.46) were also more likely to have gonorrhea testing. Similar as gonorrhea testing, participants who had abnormal vaginal discharge in the past year (aOR=4.09, 95%CI: 2.62–6.40), had ulcers in the genital (aOR=10.37, 95%CI: 3.23–33.31), had anal sex (aOR=2.36,95%CI:1.54–3.60), had HIV testing (aOR=5.16,95%CI: 3.21–8.30) and syphilis testing (aOR=6.90,95%CI: 4.21–11.32) were more likely to have chlamydia testing. Conclusion Gonorrhea and chlamydia testing rates remain low among FSW in China. Interventions that can further improve the uptake of gonorrhea and chlamydia are further needed. Providing gonorrhea and chlamydia testing at syphilis/HIV testing sites and among asymptomatic FSW may increase testing rate. Disclosure No significant relationships.

Background Social apps provided important channels for people to communicate with each other. However, social network apps use also created a unique chance for casual partner seeking. This study aimed to know the situation of the using of social apps for partner seeking purpose among men who attend STDsclinics (MSCs) and to describe sexual behaviors among users. Methods We conducted a cross-sectional study amongMSCs recruited from 9 cities in Guangdong, China from March to August in 2018. Data on socio-demographics, sexual behaviors and social app use for sex-seekingwere collected. Multivariable logistic regression models were used to identify the factors associated withpartner seeking through social apps. Results A total of 1954 participants were recruited, with a mean age of 39.9 (SD: 13.9). Overall, 228 (11.7%) ever used a mobile app for partner-seeking. Among people seeking partner through social apps, 36.6% have one more partners, 14.0% met their partnersin-person within 24 hours, and 33.8% engaged incondomless intercourse with the last partner found through social apps. Only 27.2% of them negotiated about condom use before meeting in-person, and 12.3% asked for HIV status of the last partner before meeting in-person. Sex-seeking appsuse was positively associated with having casual partners in the last three months (aOR=3.5, 95%CI 2.6–4.7), everhaving anal sex with men (aOR=21.5, 95%CI 10.6–43.6), and not receiving HIV prevention services (aOR=7.9, 95%CI 5.6–11.3). Condomless intercourse with the last partner was positively associated with having more than three partners from app (aOR=5.0, 95%CI 1.9–13.2) and negotiating about condom use with the partner before meeting in-person (aOR=2.2, 95%CI 1.2–4.4). Conclusion Social apps use has become an important sex-seekingroute among Chinese MSCs, which may facilitate the transmission of STDs. Social apps-based interventions are urgently needed. Disclosure No significant relationships.

Background Crowdsourcing method is an excellent tool for developing tailored interventions to improve sexual health. We evaluated the implementation of an innovation contest for sexual health promotion in China. Methods We organized an innovation contest over three months in 2014 for Chinese individuals Results We received 96 image submissions from 76 participants in 10 Chinese provinces. Most participants were youth ( Conclusion Innovation contests may useful for soliciting images as a part of comprehensive sexual health campaigns in low- and middle-income countries. Future sexual health campaigns should incorporate face-to-face interactions where participants can ask questions and solicit feedback about their submission ideas. Disclosure No significant relationships.

Background The epidemic of the N. gonorrhoeae infection is rapidly increasing since 2015 in China. The aims of this study were to explore the changes of antibiotic susceptibility and molecular characterization of N. gonorrhoeae in Guangdong, China, during 2013–2017. Methods A total of 704 strains were collected consecutively from two cities in Guangdong, China, during 2013–2017. Minimum inhibitory concentrations to 6 antimicrobials were assessed through the agar dilution method. Penicillinase-producing N. gonorrhoeae (PPNG) and tetracycline-resistant N. gonorrhoeae (TRNG) were characterized for the plasmid type. All isolates collected in 2013, 2014 and 2017 were genotyped by N. gonorrhoeae multi-antigen sequence typing (NG-MAST). All statistical analyses were performed using the SPSS 20.0 (IBM) software. Results Of the 704 consecutive gonococcal isolates, high resistance to penicillin (68.2%), tetracycline (85.7%) and ciprofloxacin (98.2%) were observed during the study period. Spectinomycin, Ceftriaxone and Azithromycin appeared to be effective agents with sensitivity of 100%, 96.4% and 90.7%, respectively. The penicillin- and azithromycin-resistant rates decreased from 78.4% (80/102) to 73.6% (120/163) (P=0.001) and 9.8% (10/102) to 3.7% (6/163) (P=0.004). The total prevalence of PPNG, TRNG and PPNG/TRNG was 25.4%, 33.1% and 13.4%, respectively, in which the African-type PPNG increased from 6.9% (7/102) to 15.3% (25/163) (P =0.046) instead of decreasing Asian- type PPNG from 30.4% (31/102) to 8.0% (13/163) (P Conclusion The African-type PPNG and the American-type TRNG were increased, and more novel STs strains were emerged in Guangdong. The gonococcal isolates with new genotypes might contribute to the raising epidemic of gonorrhea in this area. Disclosure No significant relationships.