BACKGROUNDHeterosexual sex has become the dominant transmission route in China. Recently studies reported high heterogeneity in heterosexual transmission risk in resource-limited countries. The aim of this study was to summarize the risk of HIV transmission among Chinese serodiscordant couples.

METHODSA systematic review and meta-analysis of observational studies of heterosexual HIV transmission among serodiscordant couples in China was conducted. Two reviewers conducted a literature search using the China National Knowledge Infrastructure (CNKI), Chinese Medical Current Contents (CMCC), and Medline databases. Pooled transmission estimates per 100 person-years (PY) were calculated using a random-effects model. Meta-regression analysis and subgroup analysis stratified by study design, transmission direction and period of antiretroviral therapy (ART) availability were conducted to assess the factors associated with transmission.

RESULTSEleven eligible studies were identified reporting on 11 984 couples and 405 HIV transmission events. HIV transmission risk from HIV-positive individuals to heterosexual partners was 1.68 (95%CI 0.74 - 2.62) per 100 PY. Study design did not reach statistical significance in meta-regression analysis. The pooled female-to-male transmission estimate was 1.11 (95%CI 0.09 - 2.14) per 100 PY and male-to-female transmission estimate was 1.43 (95%CI 0.19 - 2.68) per 100 PY. The pooled estimate for those before the availability of the Chinese National Free Antiretroviral Therapy Program (2.13 (95%CI 0.00 - 4.63) per 100 PY) was higher than that for those after the implementation of this program (1.44 (95%CI 0.62 - 2.26) per 100 PY).

CONCLUSIONSTransmission estimates in China were lower than other developing countries, but higher than developed countries. Research that better defines HIV secondary transmission rates and the associated behavioral, treatment adherence, and health-related risk factors among heterosexual serodiscordant couples in China is needed.

We report two cases of unusual manifestations of secondary syphilis accompanied by human immunodefiency virus infection. The first case is a 57-year-old heterosexual man with human immunodeficiency virus (HIV) seropositivity and unusual manifestations of secondary syphilis. The second case is a 28-year-old man presented with unusual cutaneous lesions of secondary syphilis. The following laboratory tests showed that the patient was seropositive for HIV. Both patients' cutaneous lesions resembled those of a patient with Reiter's syndrome such as keratoderma blennorrhagicum and circinate balanitis. The VDRL test of the first case showed the prozone phenomenon (false-negative in undiluted specimen).
Adult ; Balanitis ; Heterosexuality ; HIV* ; Humans* ; Keratosis ; Male ; Middle Aged ; Syphilis*

We report a case of HIV, infection associated with syphilis. A 40-year-old heterosexual man presented with headache, malaise, and a cutaneous lesion consisting of a whitish patch and petechiae on the hard palate. The serum VDRL titer wss positive at 1:64 and the cerebrospinal fluid VDRL titer was negative. Anti-HIV antibodies were detected in the patient sera by particle agglutination test and confirmed by Western blot test.
Adult ; Agglutination Tests ; Antibodies ; Blotting, Western ; Cerebrospinal Fluid ; Headache ; Heterosexuality ; HIV* ; Humans* ; Palate, Hard ; Purpura ; Syphilis*

To identify strategies to prevent sexual problems in teenage girls, respondents in this study answered two open-ended questions: "What are strategies for teenage school girls to prevent unwanted coitus?" and "What are strategies for teenage girls to prevent pregnancy?" The respondents were 12,733 girls from an accessible population of 19,000, a multi-stage cluster sample from a population of 1,988,902 girls attending 4,684 schools in the seven largest cities and nine provinces in Korea. Data were collected by mail between October 2 and October 28, 2000. The response rate was 68.9%. The total number of responses for the first question was 10,345, and for the second, 9,624. Data were analyzed by content analysis. The results of this study are: 1. According to priority, frequent strategies to prevent unwanted coitus were, self assertiveness (35.7%), heterosexual interaction training (24.6%), sex education (21.2%), and innovations in the system of social culture (4.7%). The order of priority was the same whether the respondents had experienced coitus or not. 2. According to priority, frequent strategies to prevent pregnancy were, heterosexual interaction training (27.4%), sex education (26.2%), contraceptive use and induced abortion (21.4%), and innovations in the system of social culture (3.2%). The first priority for the respondents who had not experienced coitus was heterosexual interaction training (27.7%) but contraceptive use (35.5%) was the first priority for the group who had experienced coitus. In sex education, a focus on contraceptive use for teenage girls who have experienced coitus and on heterosexual interaction training for those who have not, would strengthen preventive strategies for these two sexual problems. Assertiveness training as part of sex education would further strengthen prevention strategies.
Abortion, Induced ; Assertiveness ; Coitus ; Surveys and Questionnaires ; Female* ; Heterosexuality ; Humans ; Korea* ; Postal Service ; Pregnancy ; Sex Education

A retrospective study of 152 heterosexual male patients with non-gonococcal urethritis (NGU) was carried out to find out the efficacious treatment of NGU. We obtained urethral swabs for analysis by Chlamydiazyme (Abbott, North Chicago, IL) and Gram's stain from all patients. We classified the patients into two groups: 72 patients with no history of treatment (group I), and 80 patients with recurrent or persistent NGU (group II). Doxycycline was initially administered to 130 patients about two weeks. Ciprofloxacin, erythromycin, or doxycycline as second-line antibiotics were used in the patients with recurrent or persistent NGU after treatment with doxycycline. C. trachomatis was detected in 50 (32.9%) of the 152 patients: a larger proportion (40.3%) of the group I than the group II (26.3%) was chlamydia-positive, but the difference between two groups was not significant (p>0.05). After treatment with doxycycline, a higher cure rate was observed in the chlamydia-positive men (72.5% ; 29 of 40 patients) than in the chlamydia- negative men (50.0% ; 45 of 90 patients): in 90 chlamydia-negative men, 27 (75.0%) of 36 patients of the group I and 18 (33.3%) of 64 patients of the group II was cured (p<0.05). Doxycycline was efficacious for the chlamydia-positive men. But the patients with recurrent or persistent chlamydia-negative NGU were tend to be resistant to doxycycline therapy.
Anti-Bacterial Agents ; Chlamydia trachomatis ; Ciprofloxacin ; Doxycycline* ; Erythromycin ; Heterosexuality ; Humans ; Male ; Retrospective Studies ; Urethritis*

BACKGROUND: This study was performed to characterize the epidemiologic and clinical features of outbreak of syphilis among HIV sero-positive patients in Korea. MATERIALS AND METHODS: A retrospective case review of patients diagnosed with primary and secondary syphilis from July 1999 to September 2003 was carried out at Seoul National University Hospital in Korea. To estimate the incidence, person-years (PYs) of all HIV sero-positive patients, who visited the hospital in the same period, were calculated every 6 months. RESULTS: In a 51 month period, 465 HIV-positive patients were followed up at Seoul National University Hospital. 38 cases of primary and secondary syphilis were diagnosed. The incidence of primary and secondary syphilis was 4.1 per 100 PYs during the study period. There was no case from July 1999 to December 2001, and then the incidence rose until September 2003 from 5.5 per 100 PYs in 1999 to 18.8 per 100 PYs in 2003. The rate of primary and secondary syphilis was 4.3 times higher among homosexual and bisexual men than heterosexual men (95% CI 1.87 to 11.17), and 10.9 times higher among patients who did not receive HAART than patients who were receiving HAART (95% CI 5.47 to 21.79). CONCLUSION: The outbreak of primary and secondary syphilis among HIV-positive patients started in 2002 and has been escalating, especially among homosexual/bisexual men and in patients who did not receive HAART.
Antiretroviral Therapy, Highly Active ; Bisexuality ; Heterosexuality ; HIV* ; Homosexuality ; Humans ; Incidence ; Korea* ; Male ; Retrospective Studies ; Seoul ; Syphilis*

BACKGROUND: This study was performed to characterize the epidemiologic and clinical features of outbreak of syphilis among HIV sero-positive patients in Korea. MATERIALS AND METHODS: A retrospective case review of patients diagnosed with primary and secondary syphilis from July 1999 to September 2003 was carried out at Seoul National University Hospital in Korea. To estimate the incidence, person-years (PYs) of all HIV sero-positive patients, who visited the hospital in the same period, were calculated every 6 months. RESULTS: In a 51 month period, 465 HIV-positive patients were followed up at Seoul National University Hospital. 38 cases of primary and secondary syphilis were diagnosed. The incidence of primary and secondary syphilis was 4.1 per 100 PYs during the study period. There was no case from July 1999 to December 2001, and then the incidence rose until September 2003 from 5.5 per 100 PYs in 1999 to 18.8 per 100 PYs in 2003. The rate of primary and secondary syphilis was 4.3 times higher among homosexual and bisexual men than heterosexual men (95% CI 1.87 to 11.17), and 10.9 times higher among patients who did not receive HAART than patients who were receiving HAART (95% CI 5.47 to 21.79). CONCLUSION: The outbreak of primary and secondary syphilis among HIV-positive patients started in 2002 and has been escalating, especially among homosexual/bisexual men and in patients who did not receive HAART.
Antiretroviral Therapy, Highly Active ; Bisexuality ; Heterosexuality ; HIV* ; Homosexuality ; Humans ; Incidence ; Korea* ; Male ; Retrospective Studies ; Seoul ; Syphilis*

To our knowledge, this is the first study that focuses on risk factor of urethral condyloma (UC). The subjects of our study included genital warts patients who had been diagnosed as having condyloma acuminatum of penile skin (CAPS) with/without UC. Relationship with UC of number of life time female partners, co-infection with urethritis, circumcision status, number of CAPS and wart diameter were studied by use of multivariate analysis. Co-infection with urethritis, circumcision status were risk factors of UC in heterosexual young male patients with CAPS. This information will be helpful for providing more professional counseling to patients with genital warts.
Coinfection ; Condylomata Acuminata ; Counseling ; Female ; Heterosexuality* ; Humans ; Male* ; Multivariate Analysis ; Risk Factors* ; Skin* ; Urethra ; Urethritis ; Warts

OBJECTIVE: To understand the associated factors on human immunodeficiency virus (HIV) transmission via heterosexual contact and to provide evidence for decision-maker for prevention of HIV.
 METHODS: Questionnaire survey was conducted in 250 HIV-positive persons to understand their socio-demographic characteristics and sexual behavior. Meanwhile, 431 persons who had heterosexual contact with the HIV carriers were traced to their HIV infection status. The factors associated with continued HIV transmission were reviewed by case-control analysis.
 RESULTS: Among the 432 persons, 59 were HIV-positive because of heterosexual contact. The secondary attack rate and the growth rate was 13.7% (59/431) and 0.236 (59/250), respectively. The factors associated with the spread of HIV included: the degree of knowledge on HIV/AIDS, psychological reflection after infection, the condition for condom usage among spouses, and regular sexual partners or non regular sexual partners.
 CONCLUSION The secondary attack rate and the growth rate of HIV transmission by heterosexual contact are high. Improvement of the knowledge about HIV/AIDS prevention and control, enhancement of psychological education and promotion of condom usage can reduce the risk for continued HIV transmission.
HIV Infections ; transmission ; Heterosexuality ; Humans ; Incidence ; Risk Factors ; Safe Sex ; Sexual Behavior ; Sexual Partners ; Surveys and Questionnaires

Objective: To analyze HIV transmission hotspots and characteristics of cross-regional transmission in Guangxi Zhuang autonomous region (Guangxi) based on the molecular network analysis, and provide evidence for optimization of precise AIDS prevention and control strategies. Methods: A total of 5 996 HIV pol sequences sampled from Guangxi between 1997 and 2020 were analyzed together with 165 534 published HIV pol sequences sampled from other regions. HIV-TRACE was used to construct molecular network in a pairwise genetic distance threshold of 0.5%. Results: The proportion of HIV sequences entering the molecular network of HIV transmission hotspots in Guangxi was 31.5% (1 886/5 996). In the molecular network of HIV cross-regional transmission, the links within Guangxi accounted for 51.6% (2 613/5 062), the links between Guangxi and other provinces in China accounted for 48.0% (2 430/5 062), and the links between Guangxi and other countries accounted for 0.4% (19/5 062). The main regions which had cross-regional linked with Guangxi were Guangdong (49.5%, 1 212/2 449), Beijing (17.5%, 430/2 449), Shanghai (6.9%, 168/2 449), Sichuan (5.7%, 140/2 449), Yunnan (4.2%, 102/2 449), Shaanxi (3.8%, 93/2 449), Zhejiang (2.8%, 69/2 449), Hainan (2.0%, 49/2 449), Anhui (1.5%, 37/2 449), Jiangsu (1.3%, 33/2 449), and other regions (each one <1.0%), respectively. The risk factors of entering the molecular network of HIV transmission hotspots in Guangxi included being aged ≥50 years (compared with being aged 25-49 years, aOR=1.68,95%CI:1.46-1.95), males (compared with females, aOR=1.21,95%CI:1.05-1.40), being single (compared with being married, aOR=1.18,95%CI:1.00-1.39), having education level of high school or above (compared with having education level of junior high school or below, aOR=1.21,95%CI:1.04-1.42), acquired HIV through homosexual intercourse (compared with acquired with HIV through heterosexual intercourse, aOR=1.77, 95%CI:1.48-2.12). The risk factors of cross-regional transmission included males (compared with females, aOR=1.74,95%CI:1.13-2.75), having education level of high school or above (compared with having education level of junior high school or below, aOR=1.96,95%CI:1.43-2.69), being freelancer/unemployed/retired (compared with being farmers, aOR=1.50,95%CI:1.07-2.11), acquired HIV through homosexual intercourse (compared with acquired with HIV through heterosexual intercourse, aOR=3.28,95%CI:2.30-4.72). Conclusion: There are HIV transmission hotspots in Guangxi. Guangxi and other provinces in China form a complex cross-regional transmission network. Future studies should carry out social network surveys in high-risk populations inferred from the molecular network analysis for the timely identification of hidden transmission chains and reduction of the second-generation transmission of HIV.
Acquired Immunodeficiency Syndrome ; China/epidemiology* ; Disease Hotspot ; Female ; HIV Infections/epidemiology* ; Heterosexuality ; Humans ; Male