Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress
Clinical Collections
Advances in Alzheimer’s

At a glance: The STEP trials

A round-up of the STEP phase 3 clinical trials evaluating semaglutide for weight loss in people with overweight or obesity.
ADVANCED SEARCH
Log in
Top
BMC Public Health
Published in: BMC Public Health 1/2017

Open Access 01-12-2017 | Research article

Stages of syphilis in South China – a multilevel analysis of early diagnosis

Authors: Ngai Sze Wong, Shujie Huang, Heping Zheng, Lei Chen, Peizhen Zhao, Joseph D. Tucker, Li Gang Yang, Beng Tin Goh, Bin Yang

Published in: BMC Public Health | Issue 1/2017

Login to get access

Abstract

Background

Early diagnosis of syphilis and timely treatment can effectively reduce ongoing syphilis transmission and morbidity. We examined the factors associated with the early diagnosis of syphilis to inform syphilis screening strategic planning.

Methods

In an observational study, we analyzed reported syphilis cases in Guangdong Province, China (from 2014 to mid-2015) accessed from the national case-based surveillance system. We categorized primary and secondary syphilis cases as early diagnosis and categorized latent and tertiary syphilis as delayed diagnosis. Univariate analyses and multivariable logistic regressions were performed to identify the factors associated with early diagnosis. We also examined the factors associated with early diagnosis at the individual and city levels in multilevel logistic regression models with cases nested by city (n = 21), adjusted for age at diagnosis and gender.

Results

Among 83,944 diagnosed syphilis cases, 22% were early diagnoses. The city-level early diagnosis rate ranged from 7 to 46%, consistent with substantial geographic variation as shown in the multilevel model. Early diagnosis was associated with cases presenting to specialist clinics for screening, being male and attaining higher education level. Cases received syphilis testing in institutions and hospitals, and diagnosed in hospitals were less likely to be in early diagnosis. At the city-level, cases living in a city equipped with more hospitals per capita were less likely to be early diagnosis.

Conclusions

To enhance early diagnosis of syphilis, city-specific syphilis screening strategies with a mix of passive and client/provider-initiated testing might be a useful approach.
Literature
1.
Janier M, Hegyi V, Dupin N, Unemo M, Tiplica GS, Potocnik M, French P, Patel R. 2014 European guideline on the management of syphilis. J Eur Acad Dermatol Venereol. 2014;28(12):1581–93.CrossRefPubMed
2.
Singh AE, Romanowski B. Syphilis: review with emphasis on clinical, epidemiologic, and some biologic features. Clin Microbiol Rev. 1999;12(2):187–209.PubMedPubMedCentral
3.
Workowski KA, Bolan GA, Centers for Disease C, Prevention. Sexually transmitted diseases treatment guidelines, 2015. MMWR Recomm Rep. 2015;64(RR-03):1–137.PubMed
4.
Pathela P, Braunstein SL, Blank S, Shepard C, Schillinger JA. The high risk of an HIV diagnosis following a diagnosis of syphilis: a population-level analysis of New York City men. Clin Infect Dis. 2015;61(2):281–7.CrossRefPubMed
5.
Marcus U, Ort J, Grenz M, Eckstein K, Wirtz K, Wille A. Risk factors for HIV and STI diagnosis in a community-based HIV/STI testing and counselling site for men having sex with men (MSM) in a large German city in 2011–2012. BMC Infect Dis. 2015;15:14.CrossRefPubMedPubMedCentral
6.
Fu GF, Jiang N, Hu HY, Mahapatra T, Yin YP, Mahapatra S, Wang XL, Chen XS, Babu GR, Xu XQ, et al. The epidemic of HIV, syphilis, chlamydia and gonorrhea and the correlates of sexual transmitted infections among men who have sex with men in Jiangsu, China, 2009. PLoS One. 2015;10(3), e0118863.CrossRefPubMedPubMedCentral
7.
Burchell AN, Allen VG, Gardner SL, Moravan V, Tan DH, Grewal R, Raboud J, Bayoumi AM, Kaul R, Mazzulli T, et al. High incidence of diagnosis with syphilis co-infection among men who have sex with men in an HIV cohort in Ontario, Canada. BMC Infect Dis. 2015;15:356.CrossRefPubMedPubMedCentral
8.
Wu X, Tucker JD, Hong F, Messina J, Lan L, Hu Y, Feng T, Emch ME, Liu X, Zhang C, et al. Multilevel and spatial analysis of syphilis in Shenzhen, China, to inform spatially targeted control measures. Sex Transm Infect. 2012;88(5):325–9.CrossRefPubMedPubMedCentral
9.
Liu YY, Li Z, Huang N, Li ZW, Zheng RT, Hou JL, Liu DC, Chu TS, Liu B, Tian HQ. Investigation of delayed syphilis diagnosis. China J Leprosy Skin Dis. 2014;6:362–64.
10.
Tucker JD, Yang LG, Zhu ZJ, Yang B, Yin YP, Cohen MS, Chen XS. Integrated syphilis/HIV screening in China: a qualitative analysis. BMC Health Serv Res. 2010;10:58.CrossRefPubMedPubMedCentral
11.
Lin ZCOZ, Ma YG. A study of health seeking behaviors among 489 STD patients detected by active surveillance. Chin J STD AIDS Prev Control. 2001;7:273–7.
12.
Choi KH, Zheng X, Zhou H, Chen W, Mandel J. Treatment delay and reliance on private physicians among patients with sexually transmitted diseases in China. Int J STD AIDS. 1999;10(5):309–15.CrossRefPubMed
13.
Merlo J, Chaix B, Ohlsson H, Beckman A, Johnell K, Hjerpe P, Råstam L, Larsen K. A brief conceptual tutorial of multilevel analysis in social epidemiology: using measures of clustering in multilevel logistic regression to investigate contextual phenomena. J Epidemiol Community Health. 2006;60:290–7.CrossRefPubMedPubMedCentral
14.
Tucker JD, Cohen MS. China’s syphilis epidemic: epidemiology, proximate determinants of spread, and control responses. Curr Opin Infect Dis. 2011;24(1):50–5.CrossRefPubMedPubMedCentral
15.
Yang L-G, Tucker JD, Yang B, Shen S-Y, Sun X-F, Chen Y-F, Chen X-S. Primary syphilis cases in Guangdong Province 1995–2008: opportunities for linking syphilis control and regional development. BMC Public Health. 2010;10:793.CrossRefPubMedPubMedCentral
16.
Chen L, Huang S, Hong X, Shen H, Tang W, Yang L, Zheng H, Yang B, Prevention GPCfSDaSCa. Epidemiological situation of sexually transmitted diseases in Guangdong Province in 2013. J Diagnosis Therapy Dermato-venereology. 2015;1:62–7.
17.
Shen H, Huang S, Wen M, Tan X, Feng L, Chen J, Zheng Y, Zheng H, Yang B, Wang X. Effect analysis of promoting HIV and syphilis testing in Jiangmen, Guangdong. Chin J AIDS STD. 2016;22(1):32–41.
18.
Zhang W, Du Z, Tang S, Guo P, Ye X, Hao Y. Syphilis in the economic center of South China: results from a real-time, web-based surveillance program. BMC Infect Dis. 2015;15.
19.
20.
Merlo J, Yang M, Chaix B, Lynch J, Råstam L. A brief conceptual tutorial on multilevel analysis in social epidemiology: investigating contextual phenomena in different groups of people. J Epidemiol Community Health. 2005;59:729–36.CrossRefPubMedPubMedCentral
21.
Chen Y, Tang ZZ, Shen ZY, Lan GH, Zhang HM, Zhou YJ, Zhu QY, Zhang XJ, Tang S. Investigation on the risk factors for HIV infection among elderly male clients of the commercial female sex-workers in Guangxi Zhuang Autonomous Region, in 2012. Zhonghua Liu Xing Bing Xue Za Zhi. 2013;34(11):1086–90.PubMed
22.
Lau JT, Chen R, Wang Q, Diao J, Tsui H, Yuan W. Needs assessment for STD/HIV prevention among patients with sexually transmitted diseases in southern China. Sex Transm Dis. 2003;30(8):600–8.CrossRefPubMed
23.
Corsenac P, Noel M, Rouchon B, Hoy D, Roth A. Prevalence and sociodemographic risk factors of chlamydia, gonorrhoea and syphilis: a national multicentre STI survey in New Caledonia, 2012. BMJ Open. 2015;5(9), e007691.CrossRefPubMedPubMedCentral
24.
Lu Y. Innovative strategies for HIV prevention and control on special epidemiology and social mangement in the western China’s ethnic minorities and frontier. J Yunnan Admir Coll. 2012;6:164–6.
25.
UNAIDS. On the fast-track to end AIDS by 2030: focus on location and population. 2015. p. 126.
26.
Ministry of Health of the People’s Republic of China. Syphilis prevention and control planning (2010–2020) in China. report no.: 52. China: Ministry of Health of the People's Republic of China. 2010.
27.
Ministry of Health of the People’s Republic of China. Sexually transmitted diseases prevention and management. report no.: 89. China: Ministry of Health of the People's Republic of China. 2012.
28.
Kennedy CE, Fonner VA, Sweat MD, Okero FA, Baggaley R, O’Reilly KR. Provider-initiated HIV testing and counseling in low- and middle-income countries: a systematic review. AIDS Behav. 2013;17(5):1571–90.CrossRefPubMedPubMedCentral
29.
Lan L, Wu X, Zhang C, Wen L, Tan F, Huang F. Analysis on accurate diagnosis and standardized treatment of reported syphilis cases in Shenzhen. Chin J AIDS STD. 2015;21(7):619–22.
Metadata
Title
Stages of syphilis in South China – a multilevel analysis of early diagnosis
Authors
Ngai Sze Wong
Shujie Huang
Heping Zheng
Lei Chen
Peizhen Zhao
Joseph D. Tucker
Li Gang Yang
Beng Tin Goh
Bin Yang
Publication date
01-12-2017
Publisher
BioMed Central
Published in
BMC Public Health / Issue 1/2017
Electronic ISSN: 1471-2458
DOI
https://doi.org/10.1186/s12889-016-4004-y

Other articles of this Issue 1/2017

BMC Public Health 1/2017 Go to the issue

Research Article

Mining online e-liquid reviews for opinion polarities about e-liquid features

Study protocol

Effects of community health volunteers on infectious diseases of children under five in Volta Region, Ghana: study protocol for a cluster randomized controlled trial

Research article

Local descriptive body weight and dietary norms, food availability, and 10-year change in glycosylated haemoglobin in an Australian population-based biomedical cohort

Research article

Association of nutrition club membership with markers of health: a cross sectional study

Erratum

Erratum to: Depicted serving size: cereal packaging pictures exaggerate serving sizes and promote overserving

Research article

Examining the quality of childhood tuberculosis diagnosis in Cambodia: a cross-sectional study