Community-based Survey of Prevalence and Risk Factors of Syphilis among Injection Drug Users in Sichuan Province, China

Objectives: To investigate prevalence and risk fac-tors of syphilis infection among injection drug users(IDUs) in Lianshan Yizu Autonomous Region ofSichuan province, China.Methods: From November 8th 2002 to November29th 2002, a community-based cross-sectional surveywas conducted to investigate the demographic charac-teristics and sexual behaviors of a population of IDUs.Blood samples were collected to test for syphilisinfection. A total of 379 subjects were recruitedfor the study through community outreach and peerrecruiting methods.Results: Of 379 IDUs, the syphilis prevalence amongIDUs was 15.3% (58/379). Gender, years of education,history of unprotected sex with non-steady sex part-ner in the last month, number of sex partners in thelast 6 months, frequency of sex with non-steady sexpartner in the last 6 months, and number of any newsex partner(s) in the last 6 months were associatedwith syphilis infection after univariate analysis usingthe chi-squared test. Multivariate logistic regressionanalysis showed that ethnicity (OR, 2.85; 95% CI,1.55-5.25), marriage (OR, 1.94; 95% CI, 1.04-3.62)and receiving money for sex in the last 6 months (OR, ,5.60; 95% CI, 2.65-11.85) were significantly associ-ated with syphilis infection among IDUs.Conclusions: This study found that receiving moneyfor sex in the last 6 months was significantly associ-ated with syphilis prevalence among IDUs. It isrecommended that further health education andintervention campaigns be focused on IDUs to promotesafe sexual practices.

Development and Clinical Application of a Single-tube Nested PCR Method to Amplify the DNA Polymerase Ⅰ Gene of Treponema Pallidum

Objective: To develop a sensitive, specific and simple method for detection of extremely low numbers of T. pallidum in clinical specimens, as a significant addition to the serologic tests for syphilis diagnosis. Methods: Double-tube nested PCR(DN-PCR) and single-tube nested PCR(SN-PCR) assays were performed to amplify specific fragments of the DNA poly-merase I gene(polA) of T. pallidum. Sensitivity and specificity of the two PCR assays were tested. Eighty-six whole blood specimens from persons with suspected syphilis were detected by the two nested PCR methods. The TPPA test was used as a comparison for detecting syphilis in sera from corresponding patients. Results: Only specific amplicons could be obtained during amplification of the T. pallidum polA gene and the detection limit was approximately 1 organism when analyzed on gel by the two PCR methods. Of 86 clinical specimens, 62 were positive by TPPA. Of these, 54 and 51 were positive by the DN-PCR and SN-PCR, respectively, which does not represent a statistically significant difference between the two PCR tests. Of 24 TPPA-negative specimens, 5 were positive by both DN-PCR assay and SN-PCR assay. Conclusion: The SN- polA PCR method is extremely sensitive, specific and easy to perform for detecting low numbers of T. pallidum in clinical blood specimens as a complementary to serology for syphilis diagnosis.

A Study of the Relationship_Between Levels of SIgA and IFN-γ in the Female Genital Tract and the Clinical Course of NGU

Objective： To study the relationship of local immunity in the female genital tract with the clinical course of Nongonococcal Urethritis （NGU）. Methods： We collected cervical secretions from patients and examined levels of SIgA and IFN- γ. Results： Levels of SIgA and IFN- γ in the infected group were lower than those in the uninfected group, P1〈0.05 and P2〈0.05. The level of SIgA and IFN- γ in C.t,UU and C.t＋UU infected groups were not significantly different. Comparing the negative-changed group with thenonnegative-changed group, the level of SIgA and IFN-γ was 39.22±20.04mg/L and 103.19±29.94pg/ml, 26.00±10.56mg/I and 88.21±15.10pg/ml, P1〉0.05 and P2〉0.05. Conclusion： SIgA and IFN-γ secreted by genital tractmucosa may help prevent and resist local NGU infection.However, the effect is limited, and is insufficient to eliminate infection completely and prevent reinfection.

Survey of HIV Infection among Injection Drug Users in Guangdong, China

Objective： To understand the prevalence and behavioral risk factors of HIV infection among injection drug users in the Pearl River Delta Region （PRDR） of Guangdong province, and to provide evidence for establishing effective intervention strategies. Methods： Face to face interviews were conducted and serum samples from injection drug users from detoxification centers and the community were collected for HIV screening. Results： 655 drug users were recruited and interviewed. The HIV seropositive rate was 29.0%. 99.5 % of subjects were injection drug users （IDUs）, of whom,75.4% reported sharing injection equipment. Conclusion： HIV prevalence among injection drug users is high in the PRDR of Guangdong. Injection drug use is the principal behavioral risk factor for HIV transmission. Pragmatic harm reduction programs should be implemented to prevent the spread of HIV infection.

Survey of AIDS Related KAB Among Immigrant Female Factory Workers in Dongguan City

Objective: To understand the HIV/AIDS-related knowledge, attitudes and behaviors (KAB) among immigrant female factory workers(IFFW). Methods: A cross-sectional study was conducted among IFFWs sampled from several joint- venture and private factories in Dongguan city. Results: Out of 175 sampled workers, 165 qualified for inclusion and the median age was 22. The results showed that the IFFWs had low levels of knowledge about HIV/AIDS, and held many misconceptions. Thirty three of 76 (43.4%) unmarried IFFWs had premarital sexual contact, and more than half of these contacts were one-night stands (54.5%) . More than one quarter of the women(25.9%) never used condoms, 49.4% sometimes used condoms and 24.7% used condoms every time. Twenty-eight women (31.8%) had an induced abortion because of an unexpected pregnancy. Fourteen (14.9%) had been infected with STDs, and four IFFWs(2.8%)had tried drugs before the interview. Conclusion: In order to empower the IFFWs in the city to protect themselves from HIV, and to contain the rapid spread of HIV in our province, targeted HIV/ AIDS health promotion programs should be urgently implemented among IFFWs in Dongguan city. The programs should be designed to improve the knowledge of HIV, to promote condom use, and to reduce risky behaviors.

An Analysis of HIV Monitoring in Shenzhen City from 1997 to 2002

Objectives: To monitor the prevalence and riskfactors of HIV in high-risk populations, to provide ascientific basis for policy-makers to evaluate theeffectiveness of HIV prevention, and to formulate stra-tegic measures for prevention and treatment.Methods: From 1997 to 2002, 3 110 incarceratedcommercial sex workers (CSWs) and 4 748 outpatientsof a sexually-transmitted disease (STD) departmentunderwent HIV antibody testing in Shenzhen. HIVantibody screening of samples was made by enzymelinked immunosorbent assay (ELISA).Results: Among the outpatients, the proportiondiagnosed with an STD were 71.5%, 70%, 87.5%,87.3%, 85.2%, 82.2%, respectively, in the years from1997 to 2002. The predominant STDs presented weresyphilis, non-gonococcal urethritis (NGU) and condy-loma acuminata (CA). One out-patient was found to beHIV-positive in 2001 and another in 2002, with a preva-lence of 0.25 % (1/400). During the same period, theproportion of CSW who reported always using a con-dom were 45.9%, 49.8%, 40.8%, 57.9%, 44.9%,and 58.2%. 13.4% of CSW were drug users, amongwhom 9.3% used injection drugs and 3.2% reportedsharing syringes with others. One CSW was found tobe HIV-positive in the first survey in 1998 with a preva-lence of 0.4 % (1/250). In 2002, two CSW tested posi-tive in the first semiannual study with a prevalence of0.65% (2/307), and one case in the second study, witha prevalence of 0.48% (1/210).Conclusion: The result of this surveillance indicatethat HIV is prevalent among these high-risk popula-tions of commercial sex workers and STD outpatients.

Construction and Expression of Tp0453 Recombinant Protein of Treponema pallidum and Development of Indirect ELISA for Diagnosinq Syphilis

Objectives： To clone and express Tp0453 outer membrane protein of Treponema pallidum, and to evaluate its significance in the serodiagnosis of syphilis. Methods： The immuno-dominant epitope of Tp0453 gene was amplified from the complete genome of T.pallidum by polymerase chain reactions （PCR）, subcloned into the expression vector Pqe32 to generate recombinant plasmid Pqe32/Tp0453, and was then expressed in E. coli M15. The fusion protein was purified with Ni-NTA affinity purification. Indirect ELISA was developed to detect human serum IgG antibody to T. pallidum. Results： The recombinant Tp0453 protein was successfully expressed and purified. The recombinant protein had a molecular weight of approximately 32KDa.Indirect ELISA to the recombinant protein was developed.Sixty control sera were tested by ELISA and yielded a sensitivity of 100% （30/30） and a specificity of 100% （30/30）. While testing for T. pallidum in human sera, the sensitivity and specificity of ELISA were 96.8% and 100%, respectively, when compared with TPPA test results. The concordance of results between the ELISA test and the TPPA test was 98.2%. Conclusion： The recombinant Tp0453 outer membrane protein elicited a strong immunoreaction to anti-T.pallidum IgG antibody and has great potential use in ELISA for the serodiagnosis of syphilis.

General Characteristics of HIV/AIDS Patients in Ditan Hospital

Objective: To elucidate general characteristics of HIV/AIDS patients seeking care at Ditan Hospital in an attempt to guide early diagnosis in routine medical care. Materials and methods: A retrospective analysis of 185 HIV/AIDS cases from January 1990 to June 2002 was completed using SPSS statistical analysis. Results: Male to female ratio was 1.8 :1. Subjects ranged in age from 1 year old to 64 years old. 16 cases were younger than 20 years old with the median age among the younger subset at 7.7 years. 169 cases were older than 20 years old with a median age of 36 years old. 29% of the subjects were peasants. The remaining 71%, were of other unspecified occupations. 90.8% of individuals were of Han descent while 3.7% of individuals were of a minority heritage. 50.3% of subjects were married; 23.8% have never married; 8.1% were divorced; and the remaining 17.8% were of unknown marital status. Of those represented in this study, 36.8% came from the Henan province; 17.8% were from Beijing; 8.6% were from Shanxi; 31.4% from the other 20 provinces of China; and 5.4% from outside of China. Mode of transmission: 40.0% (74/185) contracted HIV through unprotected sexual contact; 29.2% (54/185) through receiving blood or plasma transfusions; 21.1%(39/185) through donating plasma; 7 cases were intravenous drug users; 7 cases were vertically transmitted. Mode of transmission was unknown in 4 cases. Clinical categories: An included 45 cases; B included 85 cases: C consisted of 76 cases. 12 cases were deceased. Initial presentation: 39 cases presented with fever ,cough and diarrhea. 37 cases had fever and cough only. 38 cases presented with chronic diarrhea. 16 cases were discovered incidentally at time of operation. 8 cases presented with fungal infection of the oral cavity or in esophagus. The common HIV associated symptoms and opportunistic infections were: weight loss and diarrhea, respiratory diseases, der-matologic diseases, anemia , neutropenia. Diseases of other organ systems were less common. Common misdiagnoses included pneumonia, the common cold, and enteritis. Conclusion: The majority of cases were of middle age (between 30-40 years old) and had contracted HIV/ AIDS sexually.Receiving contaminated blood or plasma via a transfusion accounted for the second most common mode of transmission. Donating plasma was the third most likely mode of transmission. Initial presenting symptoms were various and complicated. Even though the majority of HIV/AIDS cases present to the general hospital, many doctors working at the general hospital are still unable to recognize the symptoms of HIV/AIDS. Thus, it is imperative to identify general characteristics of the HIV/AIDS population in order to diagnose the disease at an earlier stage and halt further transmission.

High-risk Sexual Behavior among HIV-positive Former Commercial Blood Donors in Rural Eastern and Central China

Objective： To investigate high-risk sexual behavior among HIV-positive former commercial blood donors in rural central and eastern China. Methods： From December 2003 to May 2004, a crosssectional study was conducted to investigate demographic characteristics, sexual behaviors, condom use, and knownHIV status among HIV-positive commercial blood donors.A total of 796 subjects were recruited for the study. Results： Of the 796 study subjects, 53.0% （258/487） did not use condoms, 10.9% （53/487） inconsistently usedcondoms, and 36.1% （176/487） consistently used condoms with a steady sex partner in the past threemonths. Age （OR, 0.57; 95% CI： 0.39, 0.82）, years of education （OR, 1.90; 95% Ch 1.27, 2.84） and known HIVstatus （OR, 1.66; 95% CI： 1.12, 2.45） were independently and positively associated with condom use with a steady sex partner. Of those subjects without a steady sexual partner in the past year, 63.6% （14/22） did not use condoms, 9.1% （2/22） inconsistently used condoms, and 27.3% （6/22） consistently used condoms. Conclusion： HIV counseling and education should be focused on HIV-positive blood donors to prevent a secondary spread of HIV through unsafe sexual practices.

A Study of Monocyte Excretion of TNF- α and IL-6 and Monocyte Expression of HLA Class Ⅱ Antigen In Genital Herpes

Objective: To study the role of monocytes in the pathogenesis of genital herpes. Methods: TNF- α and IL-6 levels in 27 cases of genital herpes were detected by enzyme linked immunosorbant assay (ELISA). HLA class Ⅱ antigen expression on monocytes were detected by an alkaline phosphatase anti-alkaline phosphatase method. Results: Compared with normal controls, levels of TNF- a and IL - 6 secreted by monocytes responding to LPS mitogen in vitro were significantly decreased [(3.13 ± 0.44ng/ml) vs (4.68 ± 0.54ng/ml), P<0.05 and (3.32 ± 1.06ng/ml) vs (6.46 ± 1.94ng/ ml), P<0.05, respectively]. HLA class Ⅱ antigen expression on monocytes in the genital herpes group was also significantly decreased [HLA-DR (67.48% ± 1.51%) vs (81.03% ± 1.32%), P<0.01 and HLA-DQ (29.54% ± 1.15%) vs (37.63% ± 1.79%), P <0.01 respectively]. Conclusion: These findings suggest that the decreased monocyte function may contribute to the pathogenesis of genital herpes. Augmenting or inducing monocyte function may be important in the prevention, treatment, and reduction of genital herpes cases.

Fas and Bc1-2 EXpression on T Lymphocyte Subsets in the Peripheral Blood of Relapsing Patients with Condyloma Acuminatum

Objective: To study the expression of Fas and Bcl-2proteins on T lymphocyte subsets in the peripheralblood of relapsing patients with condyloma acuminatum(CA) and healthy controls. Methods: Flow cytometry (permeabization andstaining procedure with conjugated antibodies) wasused. Results: We observed that the expression of Fasprotein on CD4^+ T lymphocyte subset of CA patientswas significantly higher than that of healthy controls(P<0.01). Conclusions: Increased expression of Fas proteinon CD4^+ T lymphocyte subset may be a cause of de-creased percentage of CD4^+ T lymphocyte subset. Thisinduces the increased ratio of CD4^+/CD8^+.

Comparison of Multiplex Fluorescent PCR with Serum Type-specific Antibody Detection in Diagnosis of Genital Herpes

Objectives: To compare multiplex fluorescent PCRwith serum type-specific antibody detection in thediagnosis of herpes simplex virus (HSV) infection andto evaluate its significance in the diagnosis of genitalherpes.Methods: We detected HSV infection in 121 speci-mens collected from patients with genital herpesusing both multiplex fluorescent PCR and serum type-specific antibody detection. HSV viral isolation wasused as the standard control.Results: When compared with the viral isolation, thesensitivity and specificity for multiplex fluorescentPCR were 100% and 88.89%, respectively afterdiscrepant analysis. The sensitivity and specificity fortype-specific antibody detection was 77.68 % and77.78 %, respectively. However, the type-specificantibody detected HSV in two asymptomatic patientswhile the multiplex fluorescent PCR couldn’t detectany HSV DNA from those specimens.Conclusions: Multiplex fluorescent PCR is a verysensitive and specific method for detection and typingof HSV in the lesion of genital herpes, it failed todetect HSV DNA from the asymptomatic patients.Serum type-specific antibody detection was a lesssensitive and specific test but could detect the specificantibody from some asymptomatic patients. Thecombination of these two techniques would allow rapid,sensitive and accurate detection and typing of HSVand help clinical diagnosis and epidemiologic survey-ing of genital herpes.

Survey of HIV/AIDS-related Knowledge, Attitude and Determinants in Urban Residents

Objectives: To provide references for HIV/AIDS-re-lated health education strategies through survey onHIV/AIDS-related knowledge, attitude and determi-nants of HIV/AIDS awareness. Methods: The study subjects were selected by ran-dom interception in a downtown street of Guangzhoucity on World AIDS Day-December 1,2002. The uni-form questionnaires were finished by means of self-administration. Results: Two hundred questionnaires were distrib-uted and 147 qualified questionnaires were collected.The results showed, the awareness rate of HIV/AIDS-related knowledge was 63.3%, and awareness rate oftransmission routes was 76.2%, whilst non-transmis-sion route was 60.5%; the awareness rate of trans-mission was 59.2%; the awareness rate of preventionwas 47.0%; the positive attitude to people living withHIV/AIDS was 65.6%. Multiple variable Logistic re-gression analysis showed the determinants of HIV/AIDS-related knowledge were education level, age,marital status and gender, of which people with highlevel of education, young age and the group of maleand married had better awareness of HIV/AIDS. Conclusion: Current HIV/AIDS-related knowledgeof urban residents is relativly low, especially for thenon-transmission route, hence further HIV/AIDS-re-lated education should be strengthened, especially fo-cusing on non-transmission route to eliminate dis-crimination over people living with HIV/AIDS.Further, education efforts also should be put on fe-male population, unmarried population and poorly edu-cated population.

Condom Use in Commercial Sex Workers and Clients Among Incarcerated Sexworkers and STD Clinic Attendees in Jinan, Shandong Province

Background: Commercial sex workers and clientsare important core populations in the transmission ofsexually transmitted diseases (STDs) and human im-munodeficiency virus (HIV) infection. Research on thefrequency and determinants of condom use in com-mercial sex workers and their clients is important inincreasing condom use and reduction of the STD/HIV.Burden. Objectives: To establish the frequency of and fac-tors related to intention to use condoms and actualcondom use in commercial sex contacts and to deter-mine the differences in condom use between sex work-ers and clients.Methods: Incarcerated commercial sex workers(ICSW) and male STD clinic attendees were recruitedinto a cross-sectional study to obtain data on the fre-quency and factors associated with intention to usecondoms and condom use in commercial sexual con-tacts with an interviewer-administered questionnaire.Consistent condom use in ICSWs and never usingcondoms in male STD clinic attendees were analyzedusing univariate and multivariate logistic regressionmodels. Results: The frequency of reported consistent in-tention to use condoms and reported actual condomuse was 62% and 50.6%, respectively among 158ICSWs. For male STD clinic attendees, the propor-tion of reported consistent intention to use condomsand reported actual condom use was 10% and 20.7%,respectively. The factors positively influencing theconsistent intention to use condoms were pregnancypreventing measures and the belief of condom efficacyin the prevention of STD/HIV, whereas the factor as-sociated with actually consistent condom use was preg-nancy-preventing measure in ICSWs. Factors associ-ated with no intention to use condoms were low income,low STD/HIV knowledge level and the frequency ofvisiting CSW. The latter factor was also associatedwith never using condoms in male STD clinicattendees. Conclusions: Consistent condom use during com-mercial sex contacts was low, especially in clients.Greater effort is needed in condom promotion programin order to raise the level of condom use in commer-cial sex contacts.

Polymerase Chain Reaction for Detection of Mycoplasma Genitalium

Objective: To study the incidence of mycoplasmagenitalium infection in non-gonococcal urethritis(NGU)/mucopurulent cervicitis (MPC) patients.Method: Polymerase chain reaction (PCR) wasconducted to detect M. genitalium in the urogenitaltracts of 236 patients with NGU/MPC.Results: There was a specific M. genitalium band in42 out of 236 STD patients who were positive for M.genitalium by PCR.Conclusion: The results indicate that mycoplasmagenitalium exists among sexually transmitted diseasepatients. It may be one of the etiological agents of NGU/MPC.

Combination of Circumcision and Microwave in Treatment of Genital Warts in Uncircumcised Patients

Objective: To investigate the efficacy of combina-tion of circumcision and microwave on genital wartsin uncircumcised men. Methods: A randomized, prospective study of 109uncircumcised adult men with genital warts was con-ducted in a STD clinic in Zhanjiang, Guangdong. Onegroup (n=54) received microwave therapy only, whilethe other group (n=55) was taken the combination ofcircumcision and microwave therapy. The recurrenceswere observed at the end of months 3, 6 and 12, andoperative complications were also recorded. Results: There were no significant differences inthe mean age and duration of the disease between twogroups (P>0.05). No serious operative complicationswere documented. The recurrence rate in circumci-sion plus microwave group was markedly lower thanthat in microwave group (12.7% vs 29.6%, P<0.05),while the differences in early and late recurrencesbetween two groups showed no statistical significance(P>0.05). Conclusion: Circumcision can be safely performedunder local anesthesia in an outpatient setting. Com-bination of circumcision and microwave can produceexcellent effect as well as less tissue damage,therefore, it may be ideal for uncircumcised patientswith extensive condylomas.

A Case of Misdiagnosis of Palm and Plantar Pustule-formed Secondary Syphilid

IN JUNE, 2002, a 58-year-old man came to our hospitalfor pustules of his palms and soles. Half a yearearlier, erythema appealed in both his palms and soleswithout obvious cause, scales, pains or itches. Thengrain-sized pustules appeared without drying up andscab formation.

Comparative Study of PCR Kits with Cell Culture and LCR in the Detection of Chlamydia Trachomatis Infections

Objective: To determine the diagnostic performancesof six Chinese PCR kits for detection of Chlamydiatrachomatis in patients with sexually transmitteddiseases using cell culture and LCR as references.Methods: Endocervical or urethral swab specimenswere collected from 673 patients attending STDclinics in Beijing, Shanghai, Nanjing and Tianjin. C.trachomatis culture and PCR were performed onspecimens from all patients while LCR detection wasperformed only on specimens with discordant cultureand PCR results.Results: Of the 616 patients, 6.3% (39) wereculture-positive while 23.5% to 28.7% were positiveby PCR testing. Compared to cell culture, the sensi-tivity of all six PCR methods was 90% or higher. In200 cases with discrepant reports, LCR and PCRshowed excellent consistency (YI index: 0.523-0.881 ), the sensitivity and specificity of PCR methodswere 83.9%- 98.6% and 66.7%- 94.7% respectively,while PCR2 showed the highest YI index (0.881). Withthe reference standard defined as culture positive orLCR positive plus at least one PCR positive fordiscrepant results, we found that the specificity andsensitivity of all six Chinese PCR kits were higherthan 95% and 85%, respectively.Conclusions: Domestically-produced PCR kits forChlamydia trachomatis detection are highly sensi-tive and specific, however, quality control remainsimportant in their clinical application.

Effect of HSV-2 Infected Monocytes on the Production of TNF-a and IL-6

Objective: In order to detect the role of monocytes inHSV-2 infection, we studied the effect of herpes sim-plex Virus-2 infection on the production of tumor ne-crosis factor (TNF-σ), interleukin-6 (IL-6) secretedby monocytes. Methods: Monocytes were infected by HSV-2 (333Strain). Culture supernatants were collected at 1, 3,5, 7 days post-infection. The levels of TNF-α, IL-6were measured by enzyme-linked immunosorbent as-say (ELISA). Results: The levels of TNF-α secretion by mono-cytes significantly decreased on first day post-infection. The levels of IL-6 significantly decreasedon first and third days post-infection, and then gradu-ally increased to the control on seventh day post-infection. Conclusions: TNF-α and IL-6 production by mono-cytes was inhibited during HSV-2 infection. The pro-duction of cytokines may play an important role inherpes simplex viurs-2 pathogenicity and immunity.

Effect of Herpes Simplex Virus-2 Infection in Vitro on the Expression of HLA Class II Antigen of Monocytes

Objectives: In order to investigate the role of mono-cytes and human leukocyte antigen (HLA) class II an-tigen in herpes simplex virus-2 (HSV-2) infection, westudied the effect of HSV-2 infection in vitro on theexpression of HLA class II antigen on monocytes.Methods: Monocytes were infected with HSV-2(Strain 333). Culture cells were collected 1, 3, 5 and 7days after infection. The levels of expression of HLAclass II antigen were measured by using alkaline phos-phatase antialkaline phosphatase method (APAAP).Results: The levels of the expression of HLA class IIantigen on monocytes significantly decreased on thefirst day of post-infection, and then gradually returnedto levels found in the controls by the 7th day post-infection.Conclusion: HLA class II antigen expression onmonocytes was inhibited with HSV-2 infection, whichmight be one means of virus escape at an early phase.The expression of HLA class II antigen may play animportant role in herpes simplex viurs-2 pathogenic-ity and immunity.