Sexually Transmitted Infections Among Female Sex Workers in Yunnan, China

Abstract

A cross-sectional prevalence survey of sexually transmitted infections (STIs) was conducted among female sex workers (FSWs) in Kunming, Yunnan Province, China. A total of 505 FSWs participated in the survey. All eligible participants gave informed consent. Demographic, behavioral, and clinical information of the participants was gathered by direct structured interviews. Tampon swabs were collected to test for Chlamydia trachomatis, Nesseria gonorrhoeae, and Trichomonas vaginalis and serum specimens were collected to test for HIV antibody by enzyme-linked immunosorbent assay (ELISA) screening and Western blot confirmation, syphilis with rapid plasma reagin (RPR) and T. pallidum hemagglutination (TPHA) confirmation, and for HSV-2 antibodies with the HerpeSelect 2 ELISA. The most prevalent bacterial STI was Chlamydia trachomatis (58.6%), followed by Trichomonas vaginalis (43.2%) and Neisseria gonorrhoeae (37.8%). Three hundred twenty-seven (65.1%) sex workers had serologic evidence of exposure to HSV-2 infection. Ten percent were positive for HIV infection, all injecting drug users (IDUs); and 9.5% had infection with syphilis. Comprehensive prevention and effective STI services for sex workers and their clients will be the key strategies to the control of STIs, including HIV. Policies and prevention strategies for STI/HIV need to focus on high-risk subpopulations, such as sex workers (particularly sex workers who inject drugs) and their clients.

Factors Associated with Sexually Transmitted Infection Underreporting Among Female Sex Workers in China

“…The STI rate in our sample was similar to that in previous studies of FSWs in China. 13,18 Because there was no prior study that compared self-reported and biologically tested STI in FSWs in China, it is difficult to judge the extent of underreporting. However, a study conducted in drug-using FSWs in Amsterdam reported 34% underreporting of STI, 11 and a study with sexually active adolescents recruited from clinics in the United States found underreporting of STI to be 21%-47%.…”

“…However, demographic characteristics reported by our participants were similar to those observed in previous studies with different sampling methods. 13,17,18 Second, data about the history of STI testing were not available in the current study. Therefore, we could not further break down underreporting subjects into those who were tested before and those who were never tested.…”

“…12 STI has become the third most common infectious disease in China. 13 According to the National STD Surveillance System, close to 1 million new STI cases have been reported annually in recent years, and there was an average annual increase of 39% from 1985 to 2004.…”

“…13 A number of emerging social factors may be facilitating the rapid (and continued) increase in STI. 15 One of these factors is the widespread commercial sex that has played a major role in China's escalating STI epidemic.…”

“…17 FSWs recruited in STI clinics and detention centers (i.e., women's reeducation centers) reported extremely high rates of STI (as high as 85%). 13,18,19 The high STI prevalence in FSWs has drawn increasing attention; FSWs and their clients are considered the most critical populations in the spread of STI and HIV in China. 20 Nevertheless, given the large number of FSWs and the limited capacity of the current surveillance system in China, self-report of STI will continue to be used widely in studies among FSWs, especially in behavioral research of sexual risk and STI=HIV prevention.…”