| Objective: To explore the epidemiological distribution characteristics and influence factors of syphilis including contagion source and transmission route in Guangxi and to offer effective measures of preventing and controlling syphilis transmission.Methods: A cross-sectional study was conducted during the period of 1st April, 2010?1st December, 2011. Field trained personnel performed face to face interview with research object with self-designed questionnaire including five population such as female sex workers(FSW) in the place of entertainment,attendee in sexual transmission diseases clinic(STD), physical examination population, premarital test population and pregnant women. At the same time,5ml vein blood was taken for testing syphilis antibody.Results:1.The sampling number was 87388 objects, but actually 87288 study objects consisted of 2960 attendee in STD clinic, 2808 FSWs, 27550 premarital test population, 27556 physical examination population and 26414 pregnant women.2. The detection rate of syphilis was 3.1% (2714/87288 ).3. Among 2714 syphilis cases, commercial sex behavior ranked the first among transmiting routes, accounting for 48.3%. 39.6% of syphilis case suffered from sex behavior within marriage status. Commercial sex behavior was the main infection source for both FSW and attendee in STD clinic, accounting for 78.4% and 90.0%, respectively. Sex behavior with the mates in the marriage status was the main infecting source for physical examination population with the rate of 46.1% and pregnant women with the rate of 48.0%. Prospective marriage partner was the main infecting source for premarital test population with the rate of 45.6%. The distribution of syphilis transmiting route in five population was statistically different (Fisher's Exact Test:?~2 =396.852,p=0.000).4. (1)There were 67.9% the latent, 20.1% the primary, 10.4% the secondary and 1.6% the tertiary among 2714 syphilis patients. The secondary ranked the first among attendee in STD clinic with the rate of 43.6% while the latent ranked the top among FSW, physical examination population, premarital test population and pregnant women with the rate of 44.6%, 75.8%, 74.1% and 74.5%,respectively. The distribution of syphilis type was statistically different among five population (Fisher's Exact Test: ?~2=383.323, p=0.000).(2)Generalized logits model multivariate analysis?Generalized logits model indicated that regarding the latent as reference category, syphilis cases at the age of 23?26 were more subjected to contract the latent syphilis than those at the age of more than 30( ?~2 =5.845, p=0.016). Those with sex action without marriage status were easier to contract primary syphilis than the opponents (?~2=11.728, p=0.001).?The male were more subject to infect the secondary syphilis than the female by compared with the latent (?~2 =6.236, p=0.013) . Syphilis cases with sex action without marriage status had higher risk to contract the secondary syphilis by compared with the latent ( ?~2=33.332,p=0.000 ).?The male had higher risk to infect the latent ?~2=5.996, p=0.014 ). Those possessing sex action without marriage status have higher chance to contract the tertiary by compared with the latent (?~2=13.286, p=0.000 ).5. The distribution characteristics of the detection rate of syphilis for five population.Age distribution: the detection rate of syphilis for those at the age of under or equal to 23, from 23 to 26, from 26 to 30 and above 30 was 2.8%,2.3%, 2.0%and 4.7%, respectively. The difference was statistically significant (?~2=247.0,p=0.000).Gender distribution: the detection rate of syphilis female (3.2%) was higherthan male (2.9%). The difference was statistically significant (?~2=7.835,p=0.005).Education distribution: the detection rate of syphilis of people with degree under or equal to junior high school, senior high school and college or above was 3.4%, 3.2% and 2.0%, respectively. The difference was statistically significant (?~2=76.647, p=0.000).Ethnicity distribution: the detection rate( 2.8%)of syphilis for Han ethnic group was lower than Zhuang ethnic group or others (3.6%), The difference was statistically significant (?~2=76.647,p=0.000).Registered permanent address: the detection rateof syphilis for local people in Guangxi, non-local people in Guangxi and people from other provinces or foreigner was 3.3%, 2.4% and 2.5%, respectively. The difference was statistically significant (?~2=30.939,p=0.000).Marital status: the detection rate (3.5%)of syphilis for those who were married was higher than unwed people (2.9%), The difference was statistically significant (?~2=24.661,p=0.000).Geographic location: the detection rate of syphilis in Eastern Guangxi,Central Guangxi, Southern Guangxi, Northern Guangxi and Western Guangxi was 3.4%, 3.0%, 2.5%, 2.7% and 4.5%, respectively. The difference was statistically significant ( ?~2=133.5,p=0.000).Population distribution: The detection rate(10.3%) of syphilis of female sexual workers(FSW) was significantly higher than 6.9% in attendee in sexually transimitted diseases(STD) clinic, 2.9% in physical examination population,2.6% in premarital test population and 2.7% in pregnant women. ( ?~2=667.000,p=0.000).6.Distribution characteristics of syphilis for attendee in STD clinic,GuangxiGeographic location: the detection rate of syphilis for attendee in STD clinic in Eastern Guangxi, Central Guangxi, Southern Guangxi, Northern Guangxi and Western Guangxi was 5.7%, 6.9%, 6.6% and 5.2%,respectively.The difference was not statistically significant (?~2=6.020, p=0.198).Age distribution: the detection rate of syphilis for attendee in STD clinic at the age of under or equal to 23, from 23 to 26, from 26 to30 and above 30 was 6.6%, 8.6%, 6.2% and 6.3%, respectively. The difference was not statistically significant (?~2=4.449, p=0.217).Gender distribution: the detection rate of syphilis for the male and the female was 6.4% and 7.8%. The difference between the two groups was not statistically significant(?~2=2.129,p=0.145).Marital status: the detection rate (8.4%)of syphilis for the married was higher than the unwed (4.7%). The difference between the two groups was statistically significant (?~2=14.650, p=0.000).Educaiton distribution: the detection rate of syphilis for junior high school or lower, senior high school and college or above was 7.1%, 6.9% and 6.1%,respectively. The difference was not statistically significant(?~2=0.452,p=0.798).Ethnicity distribution: the detection rate of syphilis for Han ethnic group and Zhuang ethinc group or others was 7.0% and 6.7%. The difference was not statistically significant(?~2=0.106,p=0.745).Registered permanent address: the detection rate of syphilis for local people in Guangxi, non-local people in Guangxi and people from other province or foreigner was 6.6%, 8.8% and 10.5%, respectively. The difference was not statistically significant( ?~2=4.310, p=0.116).7. The distribution characteristics of the detection rate of syphilis for FSW in GuangxiGeographic location: the detection rate of syphilis in Eastern Guangxi,Central Guangxi, Southern Guangxi,Nouthern Guangxi and Western Guangxi was 11.2%, 10.9%, 9.5%, 10.5% and 9.7%. The difference was not statistically significant(?~2=1.778, p=0.777).Age distribution: the detection rate of FSW at the age of under or equal to 23, from 23 to 26, from 26 to 30 and above 30 was 10.8%, 10.7%, 8.2% and11.2%, respectively. The difference was not statistically significant(?~2=3.905,p=0.272).Marital status: the detection rate (14.7%)of syphilis for the married FSW was statistically significantly higher than the rate (8.8%)of the unwed(?~2=19.527, p=0.000).Education distribution: the detection rate of syphilis for the junior high school or below, senior high school and college or above was 9.1%, 10.9% and11.1%, respectively. The difference was not statistically significant(?~2=2.573,p=0.276)Ethnicity distribution: the detection rate of syphilis for FSW was 10.5%and 10.0%. The difference was not statistically significant(?~2=0.184,p=0.668).Registered permanent distribution: the detection rate of syphilis for local people in Guangxi, non-local people in Guangxi and people from other provinces or foreigner was 10.9%, 8.2% and 6.9%. The difference was not statistically significant(?~2=4.574,p=0.102).8. Distribution characteristics of syphilis detection rate of pregnant women in GuangxiGeographic location: the detection rate of syphilis of pregnant women in Eastern Guangxi, Central Guangxi, Southern Guangxi, Northern Guangxi and Wesstern Guangxi was 3.9%, 2.3%, 0.4%, 2.1% and 6.9%, respectively. Thedifference was statistically significant ( ?~2=491.6, p=0.000).Marital status: the detection rate of syphilis of the married (3.4%) was significantly higher than the unwed (1.7%). The difference was statistically significant (?~2=72.597, p=0.000).Education distribution: the detection rate of syphilis of pregnant women with junior high school or below, senior high school and college or above degree was 2.7%, 2.8% and 2.6%, respectively. The difference was not statistically significant.Ethnicity distribution: the detection rate(2.2%) of syphilis of Han-Chinese pregnant women was significantly lower than Zhuang ethnic group or others(3.8%)(?~2=56.684, p=0.000).Registered permanent address: the detection rate of syphilis of local ,non-local pregnant women in Guangxi, pregnant women from other provinces or countries was 3.2%, 0.7% and 0.1%, respectively. The difference 2 among three groups was statistically significant(?~2=106.0, p=0.000).Age distribution: the detection rate of syphilis of pregnant women at the age of under or equal to 23, from 23 to 26 years, from 26 to 30 years, and above 30 was 2.2%, 3.2%, 0.3% and 5.9%, respectively. The difference among fourgroups was statistically significant(?~2=354.4, p=0.000).9.The distribution characteristics of syphilis of physical examination population in GuangxiGeographic location: the detection rate of syphilis of physical examination population in Eastern Guangxi, Central Guangxi, Southern Guangxi, Northern Guangxi and Western Guangxi was 2.4%, 3.0%, 3.2%, 2.3% and 3.4%,respectively. The difference among five groups was -statistically significant(?~2=16.540, p=0.002).Martial status: the detection rate(3.5%) of syphilis of unwed physical examination population was significantly higher than the married(2.5%)(?~2=19.211, p=0.000).Gender distribution: the detection rate of syphilis of male physical examination population was 2.8% and the female was 3.0%. The difference was not statistically significant(?~2 =0.427, p=0.514).Occupation distribution: the detection rate of syphilis of worker and farmer was 3.3% and the rate of syphilis of technical personnel, national cadre and teacher was 2.5%. The difference was statistically significant(?~2=13.947,p=0.000).Education distribution: physical examination population with under or equal to junior high school, senior high school and college or above was 3.1%,3.0% and 2.8%, respectively. The difference was not statistically significant(?~2=0.594, p=0.743).Ethnicity distribution: the detection rate of syphilis of Han ethnic and Zhuang or other minority physical examination population was 2.7% and 3.3%.The difference was statistically significant(?~2=6.751,p=0.009).Registered permanent address: the detection rate of syphilis of local ,non-local physical examination population in Guangxi, from other provinces or countries was 2.8%, 3.3% an3.3 %, respectively. The differenceamong three groups was not statistically significant(?~2=5.057, p=0.08).Age distribution: the detection rate of syphilis of physical examination population at the age of under or equal to 23, from 23 to 26, from 26 to 30 and above 30 was 2.7%,2.9%,2.8% and 3.3%, respectively. The difference was not statistically significant(?~2 =3.785, p=0.286).10.The distribution characteristics of syphilis detection rate of premarital test population in Guangxi.Geographic location: the detection rate of syphilis of premarital test population in Eastern, Central, Southern, Northern and Western Guangxi was 2.6%, 2.5%, 2.5%, 2.4% and 2.6%, respectively. The difference was not statistically significant(?~2=0.572, p=0.966).Gender distribution: the detection rate of syphilis of male and female premarital test population was 2.4% and 2.7%, The difference was not statistically significant(?~2=1.778,p=0.182).Ethnicity population: the detection rate of syphilis of Han ethnic group and Zhuang ethnic group was 2.3% and 3.0%. The difference was statisticly significant (?~2=10.666, p=0.001).Registered permanent address: the detection rate of syphilis of local,non-local premarital test population in Guangxi and from other provinces or countries was 2.7%, 2.2% and 2.0%,respectively?The difference was not statisticly significant(?~2 =4.222, p=0.121).Education distribution: the detection rate of syphilis premarital test population with under or equal to junior high school, senior high school and college degree or above was 2.6%, 2.8% and 2.0%, respectively.The difference was statisticly significant(?~2=8.866, p=0.012).Age distribution: the detection rate of syphilis of premarital test population at the age of under or equal to 23, from 23 to 26, from 26 to 30 and above 30 was 2.1%, 2.5%, 1.9% and 4.1%, respectively. The difference was statisticly significant(?~2 =69.610,p=0.000).11 .Multivariate analysis(Logistic backward) of impact factors on the detection rate of syphilis of total five population in GuangxiGeographic distribution: the risk of contracting syphilis for five population in Eastern, Central, Southern and Northern Guangxi was significantly lower than those in Wester Guangxi. The OR value was 0.683, 0.620, 0.437 and 0.482,respectively. 95%CI was from 0.605 to 0.771, from 0.537 to 0.715, from 0.387 to 0.494 and from 0.401 to 0.580.Age distribution: the five population was more possible to infect syphilis at the age of under or equal to 23, from 23 to 26, from 26 to 30 than those aged above 30 years. The OR value was 0.538, 0.624 and 0.415, respectively. 95%CI was from 0.481 to 0.603, from 0.559 to 0.696 and from 0.366 to 0.469,respectively.Gender distribution: the risk of male five population contracting syphilis was lower than the female. The OR value was 0.883. the 95%CI was from 0.812 to 0.961.Education distribution: the probability of five population with junior high school or below and senior high school to contract syphilis was 1.713 and 1.570 times higher than college or above. 95%CI was from 1.517 to 1.935 and from 1.376 to 1.792.Ethnicity distribution: the risk of Han ethnic five population to infect syphilis was lower than Zhuang or other ethnic group. The OR value was 0.876.95%CI was from 0.805 to 0.954.Marital status: the risk of the married population to contract syphilis was 1.207 times higher than the unwed. 95%CI was from 1.112 to 1.310.Knowledge about STD: the risk of population with the unawareness on STD knowledge to contract syphilis was 1.542 times higher than the awareness.95%CI was from 1.419 to 1.676.Sex action without marriage status: the probability for those who had sex behavior without marriage to infect syphilis was 8.021 higher than those who hadn't. 95% CI was from 7.408 to 8.685.12. The multivariate analysis(Logsitic backward) on impact factors on the detection rate of syphilis of FSW in Guangxi indicated that the married FSW was more easier to contract syphilis OR =1.791, p=0.000 ,95%CI=1.383?2.320).13. The multivariate analysis(Logsitic backward) on impact factors on the detection rate of syphilis of attendee in STD clinic in GuangxiMarital status: the risk of the married attendee in STD clinic to infect syphilis was 1.874 higher times than the unwed.Sex action without marriage status: the probability for those who had sex behavior without marriage to infect syphilis was 5.598 times higher than those who hadn't.14. The multivariate analysis(Logsitic backward) on impact factors on the detection rate of syphilis of pregnant women in GuangxiThe knowledge about STD: the risk of those with the unawareness on STD knowledge to catch syphilis was 8.781 times higher than those with awarenss on STD knowledge (OR=8.781, 95%CI=6.876?11.214).Geographic location: the probability of population to infect syphilis in Eastern, Central, Southern and Northern Guangxi was lower than those in Western Guangxi. The OR value was 0.241 , 0.263, 0.022 and 0.112,respectively. 95%CI was from 0.189 to 0.308, from 0.194 to 0.359, from 0.015 to 0.034 and form 0.072 to 0.173.Age distribution: the probability of pregnant women to infect syphilis at the age of under or equal to 23, from 23 to 26, from 26 to 30 was lower than those aged above 30 years. The OR value was 0.126, 0.150 and 0.020, respectively.95%CI was from 0.098 to 0.163, from 0.118 to 0.192 and from 0.012 to 0.033.Sex action without marriage status: the probability for those who had sex behavior without marriage to infect syphilis was 18.543 times higher than those who hadn't(95%CI=15.294?22.483).Marital status: the married pregnant women was more possible to infect syphilis than the unwed (OR =3.923, 95%CI=3.146-4.891).Registerd permanent address: the risk of pregnant women to contract syphilis was 16.208 times higher than those from other provinces or countries.95%CI was form 3.900 to 67.363.15. The multivariate analysis(Logsitic backward) on impact factors on the detection rate of syphilis of physical examination population in GuangxiMarital status: the married physical examination population was less possible to infect syphilis than the unwed( OR =0.781, 95%CI= 0.673?0.907).Sex action without marriage status: the probability for those who had sex behavior without marriage to infect syphilis was 4.533 times higher than those who hadn'tEthnicity distribution: the risk of Han ethnic group to infect syphilis was lower than the Zhuang or other ethnic group(OR =0.781, 95%CI=0.672?0.908)Occupation distribution: the probality of worker and farmer to infect syphilis was 1.286 times higer than technical personnel, national cadre and teacher.Geographic location: the probability of physical examination population in Eastern, Central, Southern and Northern Guangxi was higher than Western Guangxi. The OR value 0.777, 0.865, 0.791and 0.559. 95%CI was from 0.614 to 0.983, from 0.641 to 0.977and from 0.394 to 0.794.16. The multivariate analysis(Logsitic backward) on impact factors on the detection rate of syphilis of premarital test population in GuangxiAge distribution: the risk of premarital test population at the age of under or equal to 23, from 23 to 26, from 26 to 30 years was lower than above 30 years.The OR was 0.486, 0.562 and 0.449, respectivel. 95%CI was from 0.389 to 0.607,from 0.457 to 0.691 and from 0.356?0.565.The knowledge about STD: the risk of those with the unawareness on STD knowledge to catch syphilis was 1.187 times higher than those with awarenss on STD knowledge (95%CI=1.011?1.393).Ethnicity distribution: the risk of the Han ethnic premarital test population to infect syphilis was lower than Zhuang or other ethnic group . The OR was 0.830. The 95%CI was from 0.706 to 0.974.Sex action without marriage status: the probability for those who had sex behavior without marriage to infect syphilis was 13.833 times higher than those who hadn't., 95%CI was from 11.879 to 16.227.Conclusion:(1)The prevalence of syphilis was really serious in Guangxi. The detection rate of syphilis was 3.1%. The detection rate(10.3%) of syphilis of female sexual workers(FSW) was significantly higher than 6.9% in attendee in sexually transimitted diseases(STD) clinic, 2.9% in physical examination population,2.6% in premarital test population and 2.7% in pregnant women. The detectionrate(4.5%) of syphilis in Western Guangxi was the highest and that(2.5%) in Southern Guangxi was lowest.(2)Among 2714 syphilis patients, transmitting route mainly consisted of commercial sexual behavior, indicating that commercial sex action had been one of main influence factor of syphilis in Guangxi. The spreading between mates with marriage ranked the second, which showed sex behavior with the mates in the marriage status was a latent risk factor of syphilis spread.(3) The latent syphilis ranked the first and was possible to be a important contagious source.(4) The risk of five population, pregnant women and premarital test population at the age of above 30 to contract syphilis was higer than those at the age of from 23 to 26 and from 26 to 30. the male was more easier to contract syphilis than the female. People with junior high school was more easier to infect syphilis than those with senior high school and college or above. The risk of Han ethnic group such as five population, pregnant women, physical examination and premarital test population to contract syphilis was lower than Zhuang or other ethnic group. The probability of the married five population,FSW, attendee in STD clinic, and pregnant women was higher than the unwed.The probability of the total five population, pregnant women and physical examination in Western Guangxi to infect syphilis was higher than those in Eastern Guangxi, Central Guangxi, Southern Guangxi and Northern Guangxi.Workder and farmer was more possible to infect syphilis than technical personnel, national cadre and teacher.(5)Sexual action without marriage status was one of risk factors of attendee in STD, pregnant women, physical examination population and premarital test population to infect syphilis, indicating sexual action without marriage status was one of main transmiting route of syphilis in Guangxi.(6) The unawarness on STD knowledge was one of risk factors for total five population, pregnant women and premarital test to infect syphilis, showing pregnant women and premarital test with awarenss of STD knowledge had better ability to pretect themselves during the period of sexual action. |
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