Prevalence and Predictors of Syphilis in Female Sex Workers in Eastern China: Findings from Six Consecutive Cross-Sectional Surveys

PURPOSE: Female sex workers play an important role in transmitting HIV and syphilis from high-risk groups to the general population. However, epidemic trends and risk factors for syphilis in Chinese female sex workers (FSWs) remain unclear. METHODS: Using convenient sampling methods, 2482 FSWs were interviewed and tested for syphilis from 2014 to 2019, all of them were divided into two groups of high-grade FSWs and low-grade FSWs according to service solicited and clients price there were. Demographic data were collected and logistic regression analysis was used to identify risk factors for syphilis. RESULTS: 43.67% of participants have received free condoms, 76.15% of them engaged in peer education of the 2482 FSWs tested for syphilis, 107 (4.31%) were positive. The prevalence of syphilis in high-grade FSWs was significantly lower than that in low-grade FSWs (3.14% and 5.62%, respectively).The overall prevalence of syphilis increased from 3.19% to4.47%. The percentage of FSWs received free condoms and engaged in peer education increased significantly. With upgraded awareness of syphilis, the number of FSWs having protected sex also increased significantly. It is also found that low-grade female sex workers are at greater risk of syphilis than those high-grade ones (odds ratio (OR) = 1.76, 95% CI 1.18–2.63, p < 0.05). CONCLUSION: Great awareness of syphilis and the increased utilization of condom did not reduce the prevalence of syphilis, especially in low-grade FSWs group. More effective integrated interventions should be developed for such populations.