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Ceftriaxone has been used to treat gonorrhea in China and most other countries for >1 decade, but the level of decreased susceptibility or clinical resistance to ceftriaxone has increased (1). [...]

Author(s): Yue-Ping Yin 1,2,*, Yan Han 1,2, Xiu-Qin Dai 1,2, He-Ping Zheng 3,4, Shao-Chun Chen 1,2, Bang-Yong Zhu 5, Gang Yong 6, Na Zhong 7, Li-Hua Hu 8, Wen-Ling Cao [...], Background Gonorrhea remains one of the most common sexually transmitted diseases worldwide. Successful treatment has been hampered by emerging resistance to each of the antibiotics recommended as first-line therapies. We retrospectively analyzed the susceptibility of gonorrhea to azithromycin and ceftriaxone using data from the China Gonococcal Resistance Surveillance Programme (China-GRSP) in order to provide evidence for updating the treatment recommendations in China. Methods and findings In this study, we included 3,849 isolates collected from patients with a confirmed positive Neisseria gonorrhoeae (N. gonorrhoeae) culture at clinic visits during the period of 1 January 2013 through 31 December 2016 in 7 provinces. Antimicrobial susceptibility testing of gonorrhea isolates using agar dilution was conducted to determine minimum inhibitory concentration (MIC). Resistance to azithromycin (RTA) was defined as MIC [greater than or equal to] 1.0 mg/l, and decreased susceptibility to ceftriaxone (DSC) was defined as MIC [greater than or equal to] 0.125 mg/l. The prevalence of isolates with RTA was 18.6% (710/3,827; 95% CI 17.4%-19.8%). The percentage of patients with DSC fluctuated between 9.7% and 12.2% over this period. The overall prevalence of isolates with both RTA and DSC was 2.3% (87/3,827; 95% CI 1.9%-2.8%) and it increased from 1.9% in 2013 to 3.3% in 2016 (chi-squared test for trend, P = 0.03). Study limitations include the retrospective study design and potential biases in the sample, which may overrepresent men with symptomatic infection, coastal residents, and people reporting as heterosexual. Conclusions To our knowledge, this is the first national study on susceptibility of N. gonorrhoeae to azithromycin and ceftriaxone in China. Our findings indicate high rates of RTA and DSC from 2013 to 2016. Although dual therapy with azithromycin and ceftriaxone has been recommended by WHO and many countries to treat gonorrhea, reevaluation of this therapy is needed prior to its introduction in China.

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 H|V 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.

Introduction In China, an estimated 780,000 people were living with HIV at the end of 2011, according to the latest estimation conducted jointly by the Ministry of Health of China, [...], Introduction: In China, the prevalence and incidence of HIV among men who have sex with men (MSM) in large?sized cities have drawn much attention. In contrast, there has been a paucity of research focussing on the sexual health of MSM of medium?sized cities. This study fills this important gap in the knowledge by investigating the sexual health of MSM in a medium?sized city (Yangzhou) and a large?sized city (Guangzhou). Methods: A baseline survey and a prospective cohort study were conducted among MSM in Yangzhou and Guangzhou from July 2009 to September 2010. A total of 622 MSM (317 from Yangzhou and 305 from Guangzhou) were screened for eligibility. Prevalence and incidence of HIV infection, as well as its risk factors, were investigated. Results: Baseline HIV prevalence was 14.5%, and overall HIV incidence density was 6.78 per 100 person?years (PY) among Yangzhou MSM. Risk factors for HIV prevalence that were significant in multivariate models were older age, married status, unprotected sex with female partners, sexually transmitted disease (STD)?associated symptoms and syphilis positivity. Risk factors for HIV incidence that were significant in multivariate models were STD?associated symptom and syphilis positivity. Compared to Yangzhou MSM, Guangzhou MSM had a lower HIV prevalence (6.2%; p Conclusions: This study showed a high prevalence and incidence of HIV among Yangzhou MSM, which suggest a more serious HIV epidemic than that in large?sized cities. Further investigation targeting MSM in medium?sized cites is urgently needed to prevent the spread of the HIV epidemic in China.

Introduction In China, an estimated 780,000 people were living with HIV at the end of 2011, according to the latest estimation conducted jointly by the Ministry of Health of China, [...], Introduction: In China, the prevalence and incidence of HIV among men who have sex with men (MSM) in large-sized cities have drawn much attention. In contrast, there has been a paucity of research focussing on the sexual health of MSM of medium-sized cities. This study fills this important gap in the knowledge by investigating the sexual health of MSM in a medium- sized city (Yangzhou) and a large-sized city (Guangzhou). Methods: A baseline survey and a prospective cohort study were conducted among MSM in Yangzhou and Guangzhou from July 2009 to September 2010. A total of 622 MSM (317 from Yangzhou and 305 from Guangzhou) were screened for eligibility. Prevalence and incidence of HIV infection, as well as its risk factors, were investigated. Results: Baseline HIV prevalence was 14.5%, and overall HIV incidence density was 6.78 per 100 person-years (PY) among Yangzhou MSM. Risk factors for HIV prevalence that were significant in multivariate models were older age, married status, unprotected sex with female partners, sexually transmitted disease (STD)- associated symptoms and syphilis positivity. Risk factors for HIV incidence that were significant in multivariate models were STD- associated symptom and syphilis positivity. Compared to Yangzhou MSM, Guangzhou MSM had a lower HIV prevalence (6.2%; p Conclusions: This study showed a high prevalence and incidence of HIV among Yangzhou MSM, which suggest a more serious HIV epidemic than that in large-sized cities. Further investigation targeting MSM in medium-sized cites is urgently needed to prevent the spread of the HIV epidemic in China. Keywords: HIV; prevalence; incidence; risk behaviours; men who have sex with men; Yangzhou; Guangzhou.

The Challenge Poor rural populations in low- and middle-income countries (LMICs) do not have access to diagnostic laboratories. Until recently, this has meant that they could not be screened for [...]