New screening approach to detecting congenital syphilis in China: a retrospective cohort study.

BACKGROUND: Diagnosis of congenital syphilis (CS) is not straightforward and can be challenging. This study aimed to evaluate the validity of an algorithm using timing of maternal antisyphilis treatment and titres of non-treponemal antibody as predictors of CS. METHODS: Confirmed CS cases and those where CS was excluded were obtained from the Guangzhou Prevention of Mother-to-Child Transmission of syphilis programme between 2011 and 2019. We calculated sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) using receiver operating characteristics (ROC) in two situations: (1) receiving antisyphilis treatment or no-treatment during pregnancy and (2) initiating treatment before 28 gestational weeks (GWs), initiating after 28 GWs or receiving no treatment for syphilis seropositive women. RESULTS: Among 1558 syphilis-exposed children, 39 had confirmed CS. Area under the curve, sensitivity and specificity of maternal non-treponemal titres before treatment and treatment during pregnancy were 0.80, 76.9%, 78.7% and 0.79, 69.2%, 88.7%, respectively, for children with CS. For the algorithm, ROC results showed that PPV and NPV for predicting CS were 37.3% and 96.4% (non-treponemal titres cut-off value 1:8 and no antisyphilis treatment), 9.4% and 100% (non-treponemal titres cut-off value 1:16 and treatment after 28 GWs), 4.2% and 99.5% (non-treponemal titres cut-off value 1:32 and treatment before 28 GWs), respectively. CONCLUSIONS: An algorithm using maternal non-treponemal titres and timing of treatment during pregnancy could be an effective strategy to diagnose or rule out CS, especially when the rate of loss to follow-up is high or there are no straightforward diagnostic tools.

The Effect of Different Treatment Regimens and Multiple Risk Factors on Adverse Pregnancy Outcomes among Syphilis-Seropositive Women in Guangzhou: A Retrospective Cohort Study.

BACKGROUND: To eliminate mother-to-child transmission of syphilis, the Chinese government recommends a treatment regimen that slightly differs from the World Health Organization- (WHO-) recommended treatment. However, little is known about their difference in efficacy. This study is aimed at comparing the effect of China-recommended and WHO-recommend treatment regimens on adverse pregnancy outcomes (APOs) and at examining associated risk factors of APOs among syphilis-seropositive women. METHODS: Using the syphilis registry data, we retrospectively collected data from 4488 syphilis-infected pregnant women in Guangzhou during 2011-2018. Multivariate analyses were used to investigate the association between treatment regimens and APOs (ectopic pregnancy, spontaneous abortion, stillbirth, preterm birth or low birth weight, newborn smaller than gestational age, congenital syphilis, and infant death) and the association between risk factors and APOs. RESULTS: Of 3474 participants, 27.3% had at least one APO. Compared to those receiving WHO-recommended treatment, women who received China-recommended treatment were less likely to have APOs (odds ratio (OR) 0.47, 95% confidence interval (CI) 0.38-0.57), whereas those who received no treatment had 1.6 times higher odds of experiencing APOs. One common risk factor across different APOs was high levels of log2-transformed toluidine red unheated serum test (TRUST) titers before treatment (OR 1.14, 95% CI 1.10-1.19). China-recommended treatment was effective in reducing APOs for those with TRUST ≥ 1 : 8 (OR 0.21, 95% CI 0.14-0.29) and those with TRUST < 1 : 8 (OR 0.62, 95% CI 0.50-0.77). CONCLUSIONS: Syphilis-seropositive women receiving China-recommended treatment had lower odds of APOs, especially when TRUST titers before treatment were high. Findings can be used to guide health professionals to reduce APOs among syphilis-infected mothers and promote nationwide use of China-recommended treatment.

Sexual behaviours and associated risks in Chinese young people: a meta-analysis.

BACKGROUND: The earlier and unprotected sexual behaviour of young Chinese, and the consequences of these actions, have become a health concern, posing a challenge to traditional Chinese concepts. The aim of the present study was to investigate changes in sexual behaviour and associated risks among adolescents and young people in mainland China over the past three decades. METHODS: A meta-analysis was undertaken to comprehensively review the sexual behaviour of Chinese young people (aged from 10 to 24 years) over the past 30 years. Relevant data published from 1979 to 2009 in the Chinese literature database were identified and retrieved. Analysis was performed based on set criteria. RESULTS: Seventy-five studies were identified that were published after 1990. Overall, the estimated prevalence of sexual intercourse among young people was 12.6%, with an average age at sexual debut of 19.4 years. The rate of condom use at sexual debut was 37.2%; 53.6% of young people reported not using a condom during the most recent act of sexual intercourse. The rates of unintentional pregnancy and abortion among the sexually active were 15.1% and 10.8%, respectively. Reviewing the data according to decades revealed that the number of young people engaging in sexual intercourse decreased from 14.3% in 1990-1999 to 11.8% in 2000-2009. However, these rates are higher than the prevalence of sexual activity reported before 1990, which, according to sporadic studies, did not exceeded 1%. CONCLUSIONS: There have been increases in sexual activity and high-risk sexual behaviour in Chinese young people in the decades since the adoption of the open door policy in China, particularly since the mid-1990s. High-risk sexual behaviours have contributed to certain adverse consequences in adolescents and young people, such as unwanted pregnancy and sexually transmissible infection. Thus, efficacious intervention strategies need to be developed and implemented.

[Cluster analysis of smoking, alcohol drinking and other health risk behaviors in undergraduate students].

OBJECTIVE: To investigate the status of smoking and alcohol drinking behaviors in undergraduate students, and explore the relationship between smoking and alcohol drinking and other health risk behaviors. METHODS: A total of 7 979 students from 44 universities or colleges across China were sampled with multiple-stage stratified sampling method. A cross-sectional investigation on smoking, alcohol drinking and other health risk behaviors was conducted, and SPSS 13.0 was used to statistically analyze the data. RESULTS: The prevalence of current smoking and alcohol drinking behaviors was 19.6% and 42.2%, respectively. There was significant difference in different genders (male 34.1% vs. female 6.1%), geographical regions (East China 15.7% vs. Mid-China 19.0% vs. West China 29.8%), types of university (key university 17.9% vs. vocational college 21.2%) and majors (arts 15.4% vs. science and engineering 21.5%) in undergraduate students who currently smoked (P<0.01). And there was significant difference in different genders (male 58.6% vs. female 26.9%), geographical regions (East China 37.9% vs. Mid-China 42.8% vs. West China 50.8%) and majors (arts 36.4% vs. science and engineering 46.1%) in undergraduate students who currently drank (P<0.01). The incidence of health risk behaviors, such as unhealthy eating behaviors, substance abuse, bad personal health habits, intentional and unintentional injuries, in the smoking and alcohol drinking students was higher than that of the control group. CONCLUSION: The smoking and alcohol drinking status was not optimistic in undergraduate students in China, which is highly related to other health risk behaviors. Comprehensive prevention and intervention programs should be developed according to different demographic distributions.