The prevalence of HIV/HCV/HBV/ Treponema pallidum is an essential health issue in China. However, there are few studies focused on foreigners living in China. This study aimed to assess the prevalence and socio-demographic distribution of HIV, HBV, HCV, and T. pallidum among foreigners in Guangzhou in the period of 2010–2017.
Methods
A cross-sectional study was conducted to screen serological samples of 40,935 foreigners from 2010 to 2017 at the Guangdong International Travel Health Care Center in Guangzhou. Samples were tested for hepatitis B surface antigen (HBsAg), anti-HCV, syphilis antibody (anti-TPPA) and anti-HIV 1 and 2. We collected secondary data from laboratory records and used multiple logistic regression analyses to verify the association between different factors and the seroprevalence of HIV/HBV/HCV/ T. pallidum.
Results
The prevalence of HBV/HCV/HIV/ T. pallidum was 2.30, 0.42, 0.02, and 0.60%, respectively, and fluctuated slightly for 7 years. The results of multiple logistic regression showed that males were less susceptible to HBV than females (odds ratio [OR] = 0.77, 95% CI: 0.67–0.89). Participants under the age of 20 had a lower risk of HBV (OR = 0.25, 95% CI: 0.18–0.35), HCV (OR = 0.06, 95% CI: 0.02–0.18), and T. pallidum (OR = 0. 10, 95% CI: 0.05–0.20) than participants over the age of 50. Participants with an education level below high school were more likely to have HBV (OR = 2.98, 95% CI: 1.89–4.70) than others, and businessmen (OR = 3.02, 95% CI: 2.03–4.49), and designers (OR = 3.83, 95% CI: 2.49–5.90) had a higher risk of T. pallidum than others. Co-infection involved 58 (4.20%) total cases, and the highest co-infection rate was observed for HBV and T. pallidum (2.60%).
Conclusion
The prevalence of HBV/HCV/HIV/ T. pallidum was low among foreigners in Guangzhou. Region, gender, age, educational level, and occupation were risk factors for positive infection.
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Abkürzungen
HIV
Human immunodeficiency virus
HCV
Hepatitis C virus
HBV
Hepatitis B virus
T. pallidum
Treponema pallidum
HBsAg
Hepatitis B viral surface antigen
Anti-TPPA
Treponemal Pallidum Particle Agglutination
OR
Odds ratio
CI
Confidence interval
STIs
Sexually transmitted infections
Background
Sexually transmitted infections (STIs) have been recognized as major public health problems in many countries, especially in developing countries [1]. Hepatitis B virus (HBV) infection is considered to be a serious public health problem worldwide, especially in less developed countries. It is estimated that 70% of new chronic HBV infections occur in low-income countries [2]. More so, The Polaris Observatory’s collaborators reported in a survey of 128 countries that the global average HBV prevalence rate was 4.9%, with China, India, Nigeria, Indonesia, and the Philippines accounting for more than 57% of all HBsAg-positive cases [3]. The major burden from HCV infection comes from chronic infection [4], as 184 million individuals worldwide are chronic carriers of HCV [5, 6]. HIV has been spreading from high-risk populations to the general population [7], and 37 million individuals are living with HIV globally. In addition, around six million individuals are infected with T. pallidum [8]. Although T. pallidum had been eliminated from China in the 1960s by providing free screening and treatment, the first resurgent cases were recognized in China in 1979, and China’s national surveillance data show a disturbing steady spread of the disease across the country [9]. T. pallidum has been found to increase HIV infection by two to five times. HIV infection may also increase the spreading of other sexually transmitted diseases, leading to epidemiological synergies between HIV and other STIs [10]. Thus, awareness of co-infection is important because shared transmission pathways and mechanisms may suggest common preventive interventions. In addition, HBV, HCV, HIV, and syphilis can also be transmitted by mother-to-child or iatrogenic transmission, such as contaminated blood or unsterilized dental needles and syringes.
Guangdong is a province in the south of China with an estimated population of 300,000 foreigners. Guangzhou is the capital city of Guangdong. A population of foreigners lives in Guangzhou mostly for economic reasons. Currently, the prevalence of STIs among this population has not been adequately confirmed. To assess the prevalence of HIV, HBV, HCV, and T. pallidum among foreigners living in Guangzhou, we designed a cross-sectional study from 2010 to 2017.
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Methods
Study design, setting, and subjects
A cross-sectional study was approved by the “Guangdong International Travel Healthcare Center Institutional Review Board Committee.” All foreigners arriving in Guangzhou should attend Guangdong International Travel Health Care for physical examination within 6 months. Except for people with incomplete data (The data is not shown in the text), all the other foreigners were included in our study. This study was conducted anonymously. Within the study period, a total of 40, 935 people participated serological tests, including Antibody test for hepatitis B surface antigen (HBsAg), Antibody test for Hepatitis C Virus (anti HCV), Antibody test for HIV 1 and 2 (anti HIV), and T. pallidum gelatin agglutination test (anti T. pallidum/TPPA). We collected secondary data for analysis.
Statistical analysis
The difference in the prevalence of STIs between groups was compared using the χ2 tests. Multiple logistic regression analyses were performed to explore the factors associated with seropositivity. The statistically significant variables, according to the χ2 tests, were included in the multiple logistic regression models to compute the adjusted odds ratios (OR) with 95% confidence intervals (CI). The significance level was set at P < 0.05. All of the analyses were performed using SPSS 20.0.
Results
Sociodemographic characteristics
Of the 40, 935 participants, 23,309 (56.94%) were male and 17,626 (43.06%) were female. The average ages of the participates were 32.59 ± 11.86 years, with a range of 0–97 years (supplementary Table 1). As shown in Table 1, 45.90% of the participants were undergraduate students (N = 18,791), while 72.75% had a college education level or less. The majority of participants were from Europe (31.93%) and North America (22.21%). About 29.56% were students, followed by businessmen (24.08%).
Table 1
Demographic characteristics of participants, Guangzhou, 2010–2017
Characteristic
Number %
Total
40,935
100.00
Exam year
2010
4089
9.99
2011
4665
11.40
2012
4464
10.91
2013
5287
12.92
2014
5907
14.43
2015
5461
13.34
2016
5605
13.69
2017
5457
13.33
Region
Africa
5927
14.48
Europe
13,071
31.93
North America
9091
22.21
South America
2269
5.54
Oceania
693
1.69
Asia
9884
24.15
Gender
male
23,309
56.94
female
17,626
43.06
Age group
< 20
6492
15.86
20–29
14,236
34.78
30–39
9804
23.95
40–49
5557
13.58
≥ 50
4846
11.84
Education level
Less than high school
371
0.91
High school
10,620
25.94
Undergraduate
18,791
45.90
Bachelor degree or above
7582
18.52
Unknown
3571
8.72
Occupation
Business
9856
24.08
Designers/science education
4818
11.77
Students
12,102
29.56
Unemployed
2537
6.20
Others
11,622
28.39
STIs
HBV
943
2.30
HCV
173
0.42
HIV
7
0.02
TPPA
246
0.60
Prevalence of STIs
The prevalence of HBV, HCV, HIV, and T. pallidum was 2.30, 0.42, 0.02, and 0.60%, respectively (Table 1), and fluctuated slightly over the 7 years covered by the study (Fig. 1). It was found that 58 (4.2%) cases had multiple infections (Fig. 2), and the highest co-infection rate was observed for HBV and T. pallidum (2.6%) (supplementary Table 1).
Fig. 1
The positive rate of STIs screening during 2010–2017
Fig. 2
Prevalence of HBV, HCV, HIV and T. pallidum by age, region, education level, and gender groups
×
×
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As shown in Table 2, females had a higher prevalence of HBV (χ2 = 7.58, P = 0.01) than males (see Table 2, Fig. 3). There were no differences over the exam year among the STIs. The seroprevalence of HIV, HBV, HCV, and T. pallidum presented was different by geographical regions (see Table 2, Fig. 3). There was a significant difference in the seropositivity of HBV between the different age groups (χ2 = 14.15, P = 0.01). Educational level differences were also observed in the seroprevalence of HBV (χ2 = 14.94, P = 0.01) and T. pallidum (χ2 = 14.09, P = 0.01). Considering the occupation, there were significant differences for HBV (χ2 = 64.21, P < 0.001), HCV(χ2 = 26.19, P < 0.001) and T. pallidum (χ2 = 155.94, P < 0.001). However, perhaps as a consequence of the low number of HIV positive cases, the seropositivity of HIV was not different among the different social demographic characteristics.
Table 2
Prevalence of HBV/HCV/HIV/TPPA among individuals with different social demographic characteristics
Characteristic
Total
No. Positive, (%)
HBV
χ2
P
HCV
χ2
P
HIV
χ2
P
TPPA
χ2
P
Exam year
2010
155
99 (2.42)
13.61
0.06
16 (0.39)
8.72
0.27
0 (0)
18.85a
0.001a
40 (0.98)
11.70
0.11
2011
169
127 (2.72)
17 (0.36)
0 (0)
25 (0.54)
2012
131
98 (2.20)
16 (0.36)
0 (0)
17 (0.38)
2013
166
117 (2.21)
21 (0.40)
0 (0)
28 (0.53)
2014
210
133 (2.25)
31 (0.52)
5 (0.08)
41 (0.69)
2015
169
109 (2.00)
31 (0.57)
2 (0.04)
27 (0.49)
2016
187
137 (2.44)
19 (0.34)
0 (0)
31 (0.55)
2017
182
123 (2.25)
22 (0.40)
0 (0)
37 (0.68)
Gender
Male
673
440 (1.89)
7.58
0.01
102 (0.44)
7.61
0.01
4 (0.02)
0.18a
0.67a
127 (0.54)
0.73
0.39
Female
696
503 (2.85)
71 (0.40)
3 (0.02)
119 (0.68)
Region
Africa
474
346 (5.84)
125.37
< 0.001
45 (0.76)
67.12
< 0.001
2 (0.03)
8.91a
0.11a
81 (1.37)
67.96
< 0.001
Europe
266
114 (0.87)
72 (0.55)
4 (0.03)
76 (0.58)
North America
389
305 (3.35)
38 (0.42)
0 (0)
46 (0.51)
South America
78
44 (1.94)
3 (0.13)
0 (0)
31 (1.37)
Oceania
44
39 (5.63)
1 (0.14)
0 (0)
4 (0.58)
Asia
118
95 (0.96)
14 (0.14)
1 (0.01)
8 (0.08)
Age group
< 20
67
53 (0.82)
14.15
0.01
4 (0.06)
8.02
0.09
0 (0)
6.41a
0.17a
10 (0.15)
5.94
0.20
20–29
283
202 (1.42)
38 (0.27)
1 (0.01)
42 (0.30)
30–39
442
296 (3.02)
54 (0.55)
5 (0.05)
87 (0.89)
40–49
283
209 (3.76)
29 (0.52)
0 (0)
45 (0.81)
≥ 50
294
183 (3.78)
48 (0.99)
1 (0.02)
62 (1.28)
Education level
Less than high school
35
28 (7.55)
14.94
0.01
0 (0)
5.70
0.22
0 (0)
2.81a
0.59a
7 (1.89)
14.09
0.01
High school
232
161 (1.52)
28 (0.26)
1 (0.01)
42 (0.40)
Undergraduate
666
435 (2.31)
90 (0.48)
5 (0.03)
136 (0.82)
Bachelor degree or above
278
214 (2.82)
34 (0.45)
1 (0.01)
29 (0.38)
Others
158
105 (2.94)
21 (0.59)
0 (0)
32 (0.9)
Occupation
Businessmen
227
127 (1.29)
64.21
< 0.001
14 (0.14)
26.19
< 0.001
1 (0.01)
3.51a
0.48a
85 (0.86)
155.94
< 0.001
Designers
200
105 (2.18)
23 (0.48)
2 (0.04)
70 (1.45)
Students
340
250 (2.07)
33 (0.27)
3 (0.02)
54 (0.45)
Unemployed
24
21 (0.83)
1 (0.04)
0 (0)
2 (0.08)
Others
578
440 (3.79)
102 (0.88)
1 (0.01)
35 (0.3)
a for likelihood ratio chi-square; No., OR, N/A, and 95% CI represent Number, Odd Rate, No data, and 95% confidence interval, respectively
Fig. 3
Diagram showing overlap of HBV, HCV, TPPA, and HIV
×
Related factors of STIs
The results of multiple logistic regression showed that the seroprevalence of HIV, HBV, HCV, and T. pallidum varies according to the geographical region of origin. Infection with HBV, HCV, and T. pallidum was the most prevalent in foreigners from Africa. Participants from Africa (OR = 9.13, 95% CI: 6.84–12.19), North America (OR = 2.74, 95% CI: 2.08–3.60), South America (OR = 2.22, 95% CI:1.49–3.30), and Oceania (OR = 6.05, 95% CI: 4.02–9.10) had a higher seroprevalence of HBV than those from Asia. The seroprevalence of HCV in foreigners from Africa (OR = 5.33, 95% CI: 2.88–9.87) and Europe (OR = 3.06, 95% CI: 1.72–5.46) was higher than in those from Asia, and the seroprevalence of T. pallidum in Asiatic foreigners was lower than in those from Africa (OR = 17.18, 95% CI: 8.17–36.11) and South America (OR = 19.30, 95% CI: 8.81–42.29).
Among age groups, a significant increase in the positive rate of HBV was observed in the 40–49-year-old participants (OR = 1.05, 95% CI: 0.85–1.30) (see Table 3), and people under 50 had a lower seroprevalence of HCV than people over 50, especially those below 20 (OR = 0.06, 95% CI: 0.02–0.18). The same is true for T. pallidum (P < 0.001). Educational level differences in seroprevalences were also observed, as people with below high school diplomas had a higher seroprevalence of HBV than other groups (OR = 2.98, 95% CI: 1.89–4.69), and people with bachelor degree had a higher seroprevalence of HBV than other groups (OR = 1.38, 95% CI: 1.07–1.78).
Table 3
Association of HBV/HCV with different social demographic characteristics
HBV
HCV
Characteristics
No. (%)
OR (95%CI)
P-Values
No. (%)
OR (95%CI)
P-Values
Exam date
0.34
0.50
2010–2012
324(2.45)
1.07 (0.86,1.33)
0.20
49(0.37)
0.98 (0.58,1.64)
0.68
2014–2017
502(2.23)
0.93 (0.75,1.15)
0.15
103(0.46)
1.12 (0.69,1.82)
0.48
2013
117(2.21)
1.00
N/A
21(0.40)
1.00
N/A
Region
< 0.001
< 0.001
Africa
346 (5.84)
9.13 (6.84,12.19)
< 0.001
45(0.76)
5.33(2.88,9.87)
< 0.001
Europe
114 (0.87)
1.04 (0.77,1.40)
0.79
72(0.55)
3.06 (1.72,5.46)
< 0.001
North America
305 (3.35)
2.74 (2.08,3.60)
< 0.001
38(0.42)
1.53 (0.82,2.86)
0.18
South America
44 (1.94)
2.22 (1.49,3.30)
< 0.001
3(0.13)
0.72 (0.21,2.51)
0.60
Oceania
39 (5.63)
6.05 (4.02,9.10)
< 0.001
1(0.14)
0.56 (0.07,4.27)
0.57
Asia
95 (0.96)
1.00
N/A
14(0.14)
1.00
N/A
Gender
< 0.001
0.18
Male
440(1.89)
0.77 (0.67,0.89)
102(0.44)
1.25 (0.89,1.74)
Female
503(2.85)
1.00
N/A
71(0.40)
1.00
N/A
Age
< 0.001
< 0.001
< 20
53(0.82)
0.25 (0.18,0.35)
< 0.001
4(0.06)
0.06 (0.02,0.18)
< 0.001
20–29
202(1.42)
0.38 (0.31,0.48)
< 0.001
38(0.27)
0.19 (0.13,0.30)
< 0.001
30–39
296(3.02)
0.76 (0.62,0.94)
0.01
54(0.55)
0.43 (0.29,0.65)
< 0.001
40–49
209(3.76)
1.05 (0.85,1.30)
0.64
29(0.52)
0.48 (0.30,0.76)
0.002
≥ 50
183(3.78)
1.00
N/A
48(0.99)
1.00
N/A
Educational level
< 0.001
0.23
Less than high school
28(7.55)
2.98 (1.89,4.69)
< 0.001
0(0.00)
< 0.00(< 0.00,> 999.)
0.12
High school
161(1.52)
1.39 (1.05,1.84)
0.02
28(0.26)
1.10 (0.58,2.08)
0.18
Undergraduate
435(2.31)
0.83 (0.67,1.04)
0.11
90(0.48)
0.74 (0.45,1.24)
0.17
Bachelor’s degree
214(2.82)
1.38 (1.07,1.78)
0.01
34(0.45)
0.95 (0.52,1.73)
0.54
Others
105(2.94)
1.00
N/A
21(0.59)
1.00
N/A
Occupation
< 0.001
< 0.001
Businessmen
127(1.29)
0.31 (0.25,0.38)
< 0.001
14(0.14)
0.16 (0.09,0.28)
< 0.001
Designers
105(2.18)
0.30 (0.24,0.38)
< 0.001
23(0.48)
0.40 (0.25,0.65)
< 0.001
Students
250(2.07)
0.57 (0.48,0.68)
< 0.001
33(0.27)
0.36 (0.24,0.54)
< 0.001
Unemployed
21(0.83)
0.16 (0.10,0.25)
< 0.001
1(0.04)
0.04 (0.01,0.31)
0.002
Others
440(3.79)
1.00
N/A
102(0.88)
1.00
N/A
No., OR, N/A and 95% CI represent Number, Odd Rate, No data and 95% confidence interval, respectively
For occupation, there were significant differences in HBV for businessmen (OR = 0.31, 95% CI: 0.25–0.38), designers (OR = 0.30, 95% CI: 0.24–0.38), students (OR = 0.57, 95% CI: 0.48–0.68), and unemployed (OR = 0.16, 95% CI: 0.10–0.25) compared to others (Table 3). Notably, T. pallidum had a higher prevalence among businessmen (OR = 3.02, 95% CI: 2.03–4.49) and designers (OR = 3.83, 95% CI: 2.49–5.90) than in the other groups (Table 4).
Table 4
Associations of HIV/TPPA with different social demographic characteristics
HIV
TPPA
Characteristics
No.(%)
OR(95%CI)
P-Values
No. (%)
OR(95%CI)
P-Values
Exam date
0.99
0.33
2010–2012
0(0.00)
0.96 (< 0.00, > 999.)
0.92
49(0.37)
1.27 (0.82,1.96)
0.24
2014–2017
7(0.03)
> 999. (< 0.00, > 999.)
0.78
103(0.46)
1.12 (0.73,1.71)
0.96
2013
0(0.00)
1.00
N/A
21(0.40)
1.00
N/A
Region
0.50
< 0.001
Africa
2 (0.03)
1.27 (0.05,32.17)
0.34
81(1.37)
17.18(8.17,36.11)
< 0.001
Europe
4 (0.03)
1.03 (0.06,18.35)
0.18
76(0.58)
7.34 (3.53,15.27)
< 0.001
North America
0 (0.00)
< 0.00 (< 0.00,> 999.)
0.14
46(0.51)
5.00 (2.34,10.68)
< 0.001
South America
0 (0.00)
< 0.00 (< 0.00,> 999.)
0.54
31(1.37)
19.30 (8.81,42.29)
< 0.001
Oceania
0 (0.00)
0.00 (< 0.00,> 999.)
0.71
4(0.58)
4.58 (1.36,15.42)
0.01
Asia
1 (0.01)
1.00
N/A
8(0.08)
1.00
N/A
Gender
0.95
0.65
male
4 (0.02)
1.14 (0.21,6.33)
127(0.54)
0.97 (0.73,1.28)
female
3 (0.02)
1.00
N/A
119(0.68)
1.00
N/A
Age
0.46
< 0.001
< 20
0 (0)
< 0.00 (< 0.00,> 999.)
0.98
10(0.15)
0.10 (0.05,0.20)
< 0.001
20–29
1 (0.01)
0.19 (0.01,3.13)
0.46
42(0.30)
0.16(0.10,0.24)
< 0.001
30–39
5 (0.05)
1.42 (0.16,12.90)
0.39
87(0.89)
0.51 (0.36,0.72)
< 0.001
40–49
0 (0)
< 0.00 (< 0.00,> 999.)
0.98
45(0.81)
0.54 (0.37,0.81)
0.003
≥ 50
1 (0.02)
1.00
N/A
62(1.28)
1.00
N/A
Educational level
0.87
0.12
Less than high school
0 (0.00)
1.41 (< 0.00,> 999.)
0.81
7(1.89)
0.92 (0.38,2.20)
0.30
High school
1 (0.01)
626.90 (< 0.00,> 999.)
0.69
42(0.40)
0.68 (0.41,1.11)
0.78
Undergraduate
5 (0.03)
> 999. (< 0.00,> 999.)
0.29
136(0.82)
0.67 (0.44,1.02)
0.84
Bachelor’s degree
1 (0.01)
409.00 (< 0.00,> 999.)
0.58
29(0.38)
0.48 (0.28,0.83)
0.06
Others
0 (0.00)
1.00
N/A
32(0.90)
1.00
N/A
Occupation
0.39
< 0.001
Businessmen
1 (0.01)
0.98 (0.06,15.98)
0.46
85(0.86)
3.02 (2.03,4.49)
< 0.001
Designers
2 (0.04)
3.05 (0.26,35.20)
0.19
70(1.45)
3.83 (2.49,5.90)
< 0.001
Students
3 (0.02)
3.55 (0.36,35.37)
0.23
54(0.45)
1.98 (1.29,3.06)
0.002
Unemployed
0 (0.00)
0.00 (< 0.00,> 999.)
0.47
2(0.08)
0.32 (0.08,1.34)
0.12
Others
1 (0.01)
1.00
N/A
35(0.30)
1.00
N/A
No., OR, N/A, and 95% CI represent Number, Odd Rate, No data, and 95% confidence interval, respectively
Discussion
There is an epidemic in China of sexually transmitted diseases and the potential for its continued growth in the future. In addition to sexual transmission, these diseases can also be transmitted through mother-to-child transmission, hospital transmission and so on, so controlling and preventing the spread of STIs are now on the agenda [11, 12]. China set out to expand the comprehensive control program consisting of primary and secondary prevention strategies to ensure that STIs can be prevented and infected individuals can be diagnosed and treated in a timely fashion, especially high-risk individuals [13]. However, available data about the prevalence of STIs in foreigners are limited. This is the first large-scale study that detected the seroprevalences of HBV, HCV, HIV, and T. pallidum among foreigners in China.
Of the 40, 935 participants involved, 3.20% (N = 1311) had a single infection, and 0.14% (N = 58) had multiple infections. A recent study in China showed that the prevalence of HBV in people aged 1–4 years, 5–14 years, and 15–29 years was 0.32, 0.94, and 4.38%, respectively [14], in this research, the seropositivity of HBV was 2.30% (N = 943), with the increase of age, the HBV infection rate gradually increased and peaked in the group aged over 50 years, which was in accordance with data for the general population. Foreigners from Africa had the highest proportion of positive HBV rate (5.84%), which is higher than the 4.7% reported in Ethiopia, and lower than the 7.51, 11.2, and 14.96% reported in Benin [15], Cameroon [16], and Burkina Faso [17], respectively.
HCV seroprevalence among foreigners was 0.42%, which is similar to the 0.43% reported in the general population in 2006 in China [18], and it is significantly lower than 2.8%, the average level in the world [19]. Similarly, Africa had the highest rate of HCV infection (0.76%), a value that is higher than the 0.5% reported in Portharcourt [20] and the 0.4% in Ethiopia [21].
Recently, it has been reported that the seroprevalence of T. pallidum ranged from 0.31 to 0.70% among blood donors in different areas of China [22‐24]. In our study, the seroprevalence of T.pallidum (0.60%) was similar in Guangzhou (0.66%) in 2010 [22], and higher than in Nanjing(0.36%) and Xi’an [23]. Africa and South America had the highest rate of T.pallidum infection. In sub-Saharan Africa, T. pallidum still remains a severe public health problem [25]. When compared with African countries, the seroprevalence of T. pallidum infection in our study was significantly lower.
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The seroprevalence of HIV in this study was 0.02%. The prevalence rate of HIV infection reported in Guangzhou and Nanjing is 0.02 and 0.08%, respectively [26], whereas in Western China the prevalence of HIV in donors was 0.31% [27, 28]. It is worth noting that there were seven HIV infection cases in total, and five cases were undergraduates, suggesting that college students are still the main group of HIV infection. The prevalence of STIs co-infection was 4.20% in foreigners, and the HBV/ T. pallidum co-infection had the maximum proportion. There were no cases involving HIV with any other pathogens. It is possible that the policy related to HIV infection in the country of origin may explain the low prevalence observed in this research. For instance, some travellers may not be allowed to go abroad due to a HIV positive test in their country.
There are several limitations to this study that should be mentioned. First, this article used the secondary data, so the genotypes of various sexually transmitted diseases pathogens were not clear. Second, HIV cases were too small to perform a multiple linear regression, decision trees, or other statistical methods used for analysis [29]. Third, all foreigners who arrive in Guangzhou will accept a physical examination, but some data are incomplete and we removed these data from our study, which may bias the results.
Conclusion
In conclusion, the epidemiologic data presented in this paper showed the presence of STIs prevalence in foreigners living in Guangzhou. This study showed a low prevalence of STIs among foreigners. Some prevalence were consistent with the local trends. During the survey period, there was no significant decline trend in the prevalence of HBV, HCV, HIV, and T. pallidum, so we highlight the need to strengthen the current surveillance program. More observation studies on STIs burden, risk factors, and interventions are needed to provide a solid base for planning and policy change [30, 31]. Furthermore, it is essential to take comprehensive measures including this particular group to control and prevent sexually transmitted infections.
We thank LetPub (www.letpub.com) for its linguistic assistance during the preparation of this manuscript.
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Ethics approval and consent to participate
This study was reviewed and approved by the Guangdong International Travel Healthcare Center Institutional Review Board Committee. As only secondary data was used in this study, consent to participate was not required.
Consent for publication
Not applicable.
Competing interests
The authors declare that they have no competing interests.
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