Sustained high prevalence of viral hepatitis and sexually transmissible infections among female sex workers in China: a systematic review and meta-analysis

Shu Su, Eric P. F. Chow, Kathryn E. Muessig, Lei Yuan, Joseph D. Tucker, Xiaohu Zhang, Jiehui Ren, Christopher K. Fairley, Jun Jing, Lei Zhang

The 1980's economic boom has been associated with a rapid expansion of China's sex industry over the past three decades. Consequently, the spread of sexually transmitted infections (STIs) and hepatitis infections among female sex workers (FSW) has become an important public health issue in China. This study identifies prevalence and risks of hepatitis and STIs in Chinese FSWs. Four electronic databases were searched for Chinese and English language peer-reviewed studies conducted between 01/2000-12/2011 that reported prevalence of hepatitis and STIs (excluding HIV) among Chinese FSW. Following the PRISMA guidelines, meta-analysis was used to estimate pooled prevalence and 95 % confidence intervals for each infection. Three hundred and thirty nine articles (34 in English and 305 in Chinese) investigating 603,647 FSWs in 29 Chinese provinces were included in this review. Over the period 2000-2011, the seroprevalence of active hepatitis B and hepatitis C among FSW were 10.7 % (7.3-15.5 %) and 1.0 % (0.7-1.3 %), respectively. The most prevalent STI was human papillomavirus (HPV, 27.0 % [10.1-55.1 %]), followed by herpes simplex virus-2 (HSV-2, 15.8 % [11.7-20.9 %]), chlamydia (13.7 % [12.1-15.4 %]), gonorrhoea (6.1 % [5.3-7.0 %]), syphilis (5.2 % [4.8-5.7 %]), genital warts (3.3 % [2.5-4.2 %]) and Trichomonas vaginitis (2.1 % [1.5-24.2 %]). Disease burden of both hepatitis and STI among FSW were concentrated in South Central and Southwest China. In particular, chlamydia and syphilis demonstrated a significant declining trend during the studied period (P < 0.05). Compared with the general Chinese population, FSW had significantly higher prevalence of all STIs except Trichomonas vaginitis. Further, compared to the general FSW population, HIV-positive FSW had significantly higher prevalence of syphilis, chlamydia, HSV-2 and Trichomonas vaginitis. Prevalence of hepatitis and STIs remained high and mostly stable among Chinese FSW over the period of 2000-2011. Targeted STI and hepatitis surveillance and interventions should be strengthened among Chinese FSWs, especially those who are HIV-positive.