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Objectives The present study investigates the varied spatial distribution of syphilis cases in Shenzhen, China, and explores the individual-, neighbourhood- and district-level factors affecting the distribution. Methods This study uses spatial analysis and multi-level generalised estimating equations to explore the spatial distribution of reported syphilis cases among individuals in Shenzhen, Guangdong Province, China. The spatial distribution of primary/secondary and latent cases was investigated using the Moran's I-statistic. Primary/ secondary syphilis cases were compared with all syphilis cases using a three-level model with individual (n=6496), neighbourhood (n=55) and district (n=6) levels. Results A total of 6496 syphilis cases were reported in 2009 with 35.8% primary and secondary syphilis cases. Both primary/secondary syphilis cases (Moran's I value=0.33, p<0.01) and latent syphilis cases (Moran's I value=0.19, p<0.01) showed significant spatial clustering at the neighbourhood level. Adjusting for the number of reporting hospitals, the best model found that the following characteristics were associated with primary/secondary syphilis infection: individuals who are younger in age (p=0.003), male (p<0.001), migrant labourers (p=0.047) and those who live in districts with a higher gross domestic product (p<0.001). Conclusions There is substantial clustering of primary and secondary syphilis cases at the neighbourhood level in Shenzhen, suggesting the need for greater STD health service provision in these clustered neighbourhoods. Spatially targeted syphilis control measures may be useful to optimise testing, treatment and partner services. [ABSTRACT FROM AUTHOR]

Objective China's sexually transmitted infection (STI) epidemic requires comprehensive control programmes. Partner services are traditional pillars of STI control but have not been widely implemented in China. This study was a systematic literature review to examine STI partner notification (PN) uptake in China. Methods Four English and four Chinese language databases were searched up to March 2011 to identify articles on PN of STIs including HIV in China. PN uptake was defined as the number of partners named, notified, evaluated or diagnosed per index patient. Results A total of 11 studies met inclusion criteria. For STI (excluding HIV) PN, a median 31.6% (IQR 27.4%--65.8%) of named partners were notified, 88.8% (IQR 88.4%--90.8%) of notified partners were evaluated and 37.9% (IQR 33.1%--43.6%) of evaluated partners were diagnosed. For HIV PN, a median 15.7% (IQR 13.2%--36.5%) of named partners were notified, 86.7% (IQR 72.9%--90.4%) of notified partners were evaluated and 27.6% (IQR 24.1%--27.7%) of evaluated partners were diagnosed. A mean of 80.6% (SD=12.6%) of patients attempted PN, and 72.4% (IQR 63.8%--81.1%) chose self-referral when offered more than one method of PN. Perceived patient barriers included social stigma, fear of relationship breakdown, uncertainty of how to notify and lack of partner contact information. Perceived infrastructure barriers included limited time and trained staff, mistrust of health workers and lack of PN guidelines. Conclusion PN programmes are feasible in China. Further research on STI PN, particularly among men who have sex with men and other high-risk groups, is an important public health priority. PN policies and guidelines are urgently needed in China. [ABSTRACT FROM AUTHOR]

Objectives Low rates of HIV testing drive the rapidly growing HIV epidemic among men who have sex with men (MSM) in China. We examined the potential usefulness of couple-based and collective HIV testing strategies among Chinese MSM. Methods A cross-sectional online survey was conducted among 1113 MSM in 2013. Multivariable logistic regression analyses were conducted to identify factors associated with willingness to receive couple- based and collective testing. Results Acceptability of couple-based testing was very high among participants (86.1%), with a moderate level of interest in collective testing (43.2%). Being 'out' to others about one's sexual identity (adjusted OR (AOR)=1.48, 95% CI 1.01 to 2.17) and having ever had an HIV test (AOR=3.05, 95% CI 2.10 to 4.33) were associated with willingness to receive couple-based testing. Having multiple male anal sex partners in the past 3 months was associated with willingness to participate in collective testing (AOR=1.43, 95% CI 1.03 to 1.99). Discussion Couple-based and collective HIV testing could help better control the HIV epidemic among Chinese MSM if implemented and promoted in a culturally competent manner. [ABSTRACT FROM AUTHOR]

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% Cl = 1.11 to 2.62, p=0.023; primary school or less, OR= 1.98, 95% Cl = 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% Cl=1.10 to 3.28, p=0.011) and city 8 (13.8%, OR= 1.83, 95% Cl = 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. [ABSTRACT FROM AUTHOR]