Sustained high prevalence of viral hepatitis and sexually transmissible infections among female sex workers in China: a systematic review and meta-analysis

Abstract

BackgroundThe 1980’s economic boom has been associated with a rapid expansion of China’s sex industry over the past three decades. Consequently, the spread of sexually transmitted infections (STIs) and hepatitis infections among female sex workers (FSW) has become an important public health issue in China. This study identifies prevalence and risks of hepatitis and STIs in Chinese FSWs.MethodFour electronic databases were searched for Chinese and English language peer-reviewed studies conducted between 01/2000-12/2011 that reported prevalence of hepatitis and STIs (excluding HIV) among Chinese FSW. Following the PRISMA guidelines, meta-analysis was used to estimate pooled prevalence and 95 % confidence intervals for each infection.ResultThree hundred and thirty nine articles (34 in English and 305 in Chinese) investigating 603,647 FSWs in 29 Chinese provinces were included in this review. Over the period 2000–2011, the seroprevalence of active hepatitis B and hepatitis C among FSW were 10.7 % (7.3–15.5 %) and 1.0 % (0.7–1.3 %), respectively. The most prevalent STI was human papillomavirus (HPV, 27.0 % [10.1–55.1 %]), followed by herpes simplex virus-2 (HSV-2, 15.8 % [11.7–20.9 %]), chlamydia (13.7 % [12.1–15.4 %]), gonorrhoea (6.1 % [5.3–7.0 %]), syphilis (5.2 % [4.8–5.7 %]), genital warts (3.3 % [2.5–4.2 %]) and Trichomonas vaginitis (2.1 % [1.5–24.2 %]). Disease burden of both hepatitis and STI among FSW were concentrated in South Central and Southwest China. In particular, chlamydia and syphilis demonstrated a significant declining trend during the studied period (P < 0.05). Compared with the general Chinese population, FSW had significantly higher prevalence of all STIs except Trichomonas vaginitis. Further, compared to the general FSW population, HIV-positive FSW had significantly higher prevalence of syphilis, chlamydia, HSV-2 and Trichomonas vaginitis.ConclusionPrevalence of hepatitis and STIs remained high and mostly stable among Chinese FSW over the period of 2000–2011. Targeted STI and hepatitis surveillance and interventions should be strengthened among Chinese FSWs, especially those who are HIV-positive.Electronic supplementary materialThe online version of this article (doi:10.1186/s12879-015-1322-0) contains supplementary material, which is available to authorized users.

Syphilis

“…Studies in emerging economies, such as China, indicate that syphilis is increasing among ‘mobile men with money’ 31 . Although syphilis case rates are low in the general population in China, syphilis prevalence is ~5% among FSWs and 3% among their male clients 31,32 . Risk of infection varies among FSWs working in different venues, with the highest prevalence (~10%) among street-based FSWs and lower prevalence (~2%) among venue-based FSWs 33 .…”

Depression and HIV Risk Behaviors among Female Sex Workers in Guangdong, China: A Multicenter Cross-Sectional Study

“…FSWs are at high risk of HIV acquisition and are a bridge for the transmission of HIV/STDs to the general population [6]. A recent meta-analysis revealed that during 2000–2011 the high prevalence of STDs among FSWs became a severe public health issue in China [7]. …”

Uptake and Correlates of Chlamydia and Gonorrhea Testing among Female Sex Workers in Southern China: A Cross-sectional Study

“…Female sex workers (FSW) are highly vulnerable to chlamydia and gonorrhea due to their frequent sexual contact with multiple concurrent sexual partners [3]. In China, the prevalence of chlamydia and gonorrhea among FSW is 13.6% and 6.1%, respectively [4], much higher than that of general 15-49 years old women (chlamydia 3.8%, and gonorrhea 0.9%) [5]. This situation is much worse among FSW from middle and low titer (8.0% and 20.0%, respectively) [6].…”