Population-based study of chlamydial and gonococcal infections among women in Shenzhen, China: Implications for programme planning
May
Population-based study of chlamydial and gonococcal infections among women in Shenzhen, China: Implications for programme planning
Zhen-Zhou Luo 0 1
Wu Li 0 1
Qiu-Hong Wu 0 1
Li Zhang 0 1
Li-Shan Tian 0 1
Lan-Lan Liu 0 1
Yi Ding 0 1
Jun Yuan 0 1
Zhong-Wei Chen 0 1
Li-Na Lan 1
Xiao-Bing Wu 1
Yu-Mao Cai 1
Fu- Chang Hong 1
Tie-Jian Feng 1
Min Zhang 1
Xiang-Sheng Chen 1
0 Shenzhen Nanshan Center for Chronic Disease Control , Shenzhen , China , 2 Shenzhen Center for Chronic Disease Control , Shenzhen , China , 3 Chinese Academy of Medical Sciences & Peking Union Medical College Institute of Dermatology , Nanjing , China , 4 National Center for STD Control , Nanjing , China
1 Editor: Guangming Zhong, University of Texas Health Science Center at San Antonio , UNITED STATES
This study was aimed to estimate the prevalences of chlamydia (CT) and gonococcal (NG) infections and explore risk factors associated with the CT infection among women in Shenzhen, China. We collected socio-demographic and clinical data from women (aged 20±60) and determined positivity of CT or NG by nucleic acid amplification test (NAAT) with self-collected urine specimens. We estimated prevalence of CT and NG and determined risk factors associated with CT infection. Among 9,207 participants, 4.12% (95% confidence interval [CI], 3.71%-4.53%) tested positive for CT and 0.17% (95% CIs, 0.09%-0.25%) for NG. Factors significantly associated with CT infection included being an ethnic minority (ethnicity other than Han China) (Adjusted odds ratio [AOR], 1.9; 95% CI, 1.2±3.0), using methods other than condom for contraception (AOR, 1.5; 95% CI, 1.2±1.8), having a history of adverse pregnancy outcomes (AOR, 1.4; 95% CI, 1.1±1.8), and experiencing reproductive tract symptoms in the past three months (AOR, 1.3; 95% CI, 1.0±1.7). we found that CT infection is prevalent among women in Shenzhen, China and associated with both demographic and behavioral factors. A comprehensive CT screening, surveillance and treatment programme targeting this population is warranted.
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Data Availability Statement: All relevant data are
within the paper and its Supporting Information
file.
Funding: Sanming Project in Medicine in Shenzhen
(SZSM201611077) and Chinese Academy of
Medical Sciences Initiative for Innovative Medicine
(2016-I2M-3-021) supported the study. This study
was a part of the comprehensive programme for
control of chlamydial infections sponsored by the
Nanshan Bureau of Health and Family Planning of
Introduction
As major sexually transmitted infections (STIs), chlamydia caused by Chlamydia trachomatis
(C. trachomatis, CT) and gonorrhoea caused by Neisseria gonorrhoeae (N. gonorrhoeae, NG)
are important public health problems in many developed and developing countries [1±3].
According to the World Health Organization (WHO)'s most recent estimates, there were an
estimated 131 million new cases or 127 million prevalent cases of CT and 78 million new cases
Shenzhen. The funders had no role in study design,
data collection and analysis, decision to publish, or
preparation of the manuscript.
of NG in 2012 [
2
]. If left untreated, chlamydia and gonorrhoea can cause significant morbidity,
particularly in women, resulting in 30% risk to develop pelvic inflammatory disease (PID).
PID can further cause serious reproductive and obstetric sequelae including ectopic
pregnancy, tubal infertility, and chronic pelvic pain [
4, 5
]. As the most populous country in the
world, China's epidemic of STIs contributes significantly to the global burden of disease for
CT and NG. In China, the National STI Surveillance Programme, as part of the ªChina
Information System for Disease Control and Preventionº only tracks two notifiable STIs (syphilis
and gonorrhoea) through an internet-based routine reporting network on a real-time basis
[6]. Among the notifiable communicable diseases in China, STIs remain major causes of
morbidity in which syphilis and gonorrhoea have ranked third and fifth respectively in term of the
disease-specific reported incidence for more than a decade. Practically, the STI case reporting
system monitors trends in the incidence of these diseases over time based on available patient
data from health facilities. However, the asymptomatic nature of these infections, inadequate
capacities of laboratories, and incomplete coverage of the surveillance programme could lead
to a significant underreporting. In China, incidence of new STI infections is usually estimated
from yearly case reports of patients attending clinics [
7
] while monitoring of prevalence
among specific populations primarily relies on data from routine clinic-based screening
programmes such as active screening for syphilis [
8, 9
] or ad hoc surveys among specific
populations such as prevalence surveys of gonococcal and/or chlamydial infections among female sex
workers [10]. An increasing number of studies on STI prevalence have been conducted among
high-risk groups in China [
10, 1 (...truncated)