Syphilis Self-Testing Among Female Sex Workers in China: Implications for Expanding Syphilis Screening
Open accessAbstract
Background: Syphilis self-testing (SST) may help expand syphilis test uptake among female sex workers. However, there has been no studies on examining SST among female sex workers. We aim to examine SST experience and its determinants among female sex workers in China. Methods: A venue-based, cross-sectional study of female sex workers was conducted in eight Chinese cities in 2019. Participants completed a survey including socio-demographic characteristics, sexual behaviors, and SST history. Multivariable logistic regression was conducted to evaluate the associated factors with SST. Results: Among 1,287 Chinese female sex workers, 72.1% (928/1,287) had ever tested for syphilis, and 5.9% (76/1,287) had ever used syphilis self-testing. Among syphilis self-testers, more than half (57.9%, 44/76) reported that the self-test was their first syphilis test, around one-fifth (18.4%, 14/76) reported that syphilis self-testing results influenced the price of commercial sex. After adjusting for covariates, female sex workers who received anal sex in the past month (adjusted odds ratio [aOR]: 2.6, 95%CI: 1.5–4.3, p < 0.001), used drugs before or during sex (aOR: 3.8, 95%CI: 2.3–6.4, p < 0.001), tested for other sexually transmitted infections (STIs) in the past 6 months (aOR: 3.4, 95%CI: 1.9–6.0), ever tested in the hospital (aOR: 5.1, 95%CI: 2.5–10.4, p < 0.001), and ever tested in the community (aOR: 1.7, 95%CI: 1.3–2.2, p < 0.001) were more likely to perform syphilis self-testing. Conclusions: Syphilis self-testing has the potential to expand testing coverage, and increase testing frequency with limited potential harms among FSW. Further evaluation on the intervention effects based on syphilis self-testing among FSW are needed.
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Syphilis self-testing, including dual HIV/syphilis self-testing, was well accepted and desirable overall.
“Syphilis self-testing, including dual HIV/syphilis self-testing, was well accepted and desirable overall (62, 63, 67-69).”
From Updated recommendations for the treatment of Neisseria gonorrhoeae, Chlamydia trachomatis, and Treponema pallidum (syphilis) and new recommendations on syphilis testing and partner services (2024) · cites this paper as [69]
The Background says syphilis self-testing was highly accepted among men who have sex with men, and the Discussion describes integrating it into HIV self-testing services as acceptable and feasible. The paper does not establish that dual HIV/syphilis self-testing was itself well accepted or desirable overall, particularly among the female sex workers it studied. (LLM, conf=0.83)
Experimental — accuracy not yet measuredObservational studies suggested that harm related to self-testing was rare overall, but indicated some users felt pressure to test themselves and/or experienced arguments with a partner following syphilis self-testing or dual HIV/syphilis self-testing.
“Observational studies also suggested that harm related to self-testing was rare overall, but they did indicate that some users felt pressure to test themselves and/or experienced arguments with a partner following syphilis self-testing or dual HIV/syphilis self-testing (62, 69, 75).”
The systematic review included 12 publications of about seven different studies, of which two were RCTs.
“Overall, the review included 12 publications of about seven different studies (61-72), of which two were RCTs (64, 66).”
From Updated recommendations for the treatment of Neisseria gonorrhoeae, Chlamydia trachomatis, and Treponema pallidum (syphilis) and new recommendations on syphilis testing and partner services (2024) · cites this paper as [69]
The Methods (Statistical Analysis; page unavailable) describe a survey and regression analysis, not a systematic review. Searches for the claimed 12 publications, approximately seven studies, and two RCTs found no passage in our copy reporting those counts. The References list a review and a trial protocol, but neither establishes the claim. (LLM, conf=0.76)
Experimental — accuracy not yet measuredSeveral studies showed that most participants were able to correctly self-test.
“Several studies showed that most participants were able to correctly self-test (62, 64, 66-69).”
From Updated recommendations for the treatment of Neisseria gonorrhoeae, Chlamydia trachomatis, and Treponema pallidum (syphilis) and new recommendations on syphilis testing and partner services (2024) · cites this paper as [69]
The Results section on motivations and barriers reports that 73.68% of syphilis self-testers had difficulties performing the test, but does not assess whether they performed it correctly. The Methods section lists self-testing history and reported results among the measures, not observed performance or correctness. Our copy therefore does not establish that most participants were able to correctly self-test. (LLM, conf=0.76)
Experimental — accuracy not yet measured
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Cites
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- Authors
- Wang, C., Li, X., Wang, Y., & Yang, B.
- Affiliations
- Southern Medical University (CN)
- Corresponding author
- Wang, Cheng
- Venue
- Frontiers in Public Health
- Publisher
- Frontiers Media SA
- Published
- 2022-04-13
- Volume
- 10
- Pages
- 744240-744240
- ISSN
- 2296-2565 (ISSN-L)
- PMC
- PMC9045586
- OpenAlex
- W4223598662
- Cited by
- 7
- References
- 18
- Citations by year
- 2026: 3 · 2025: 2 · 2023: 2
- FWCI
- 1.44
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Licence
- Locations
- Frontiers in Public Health (publishedVersion, cc-by)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion)
- Funders
- Guangdong Medical Research Foundation
- Topics
- Social Sciences › Sociology and Political Science › Sex work and related issues
- Health Sciences › Medicine › Physiology › Syphilis Diagnosis and Treatment
- Life Sciences › Immunology and Microbiology › Microbiology › Reproductive tract infections research
- Keywords
- female sex workers, syphilis screening, sexually transmitted infections, anal sex, drug use during sex, STI screening, China
- MeSH terms
- Self-Testing, China, Cross-Sectional Studies, Female, Humans, Male, Sex Work, Syphilis, HIV Infections, Sex Workers
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