Objective To characterize the spatial distribution pattern of syphilis at the county level in China,and to provide a new method for syphilis surveillance and control.Methods A national geographic information system (GIS) database was developed based on reported cases of syphilis from all counties in China,2011.Exploratory spatial data analysis (ESDA) methods were used to study the frequency distribution of incidence,global and local spatial autocorrelation,of syphilis.Results The median incidence rate of syphilis was 21.17/100 000 (range:0.00-515.34/100 000; 25th percentile 9.28/100 000,75th percentile 43.00/100 000) in 2 925 counties in the mainland of China in 2011,with a highly positively skewed distribution (skewness =3.11).The global spatial autocorrelation analysis showed a positive spatial autocorrelation of syphilis incidence at the county level in China (global Moran's index =0.576 2,P ＜ 0.001),with the type of correlation being high-high cluster (General G index =0.033 1,P ＜ 0.001).The local spatial autocorrelation analysis delineated hot spots of syphilis (including primary and secondary syphilis,latent syphilis) at the county level.Totally,117 counties,which were mainly distributed in the Yangtze River delta region,northwest,northeastern and south China,were identified as hot spots for syphilis,with the incidence rate of primary or secondary syphilis being higher than 50/100 000.Conclusions The GIS and exploratory spatial data analysis,with the advantages of visualization and accurate localization,may serve as an important novel tool for syphilis surveillance and control.

Objective To retrieve clinical evidence for the efficacy of ceftriaxone in the treatment of early syphilis.Methods Several international and national medical databases were used to search original articles published from 1985 to 2012 and reporting the efficacy of ceftriaxone or penicillin for the treatment of early syphilis.Randomized controlled trials (RCTs) and clinical controlled trials (CCTs) were identified and retrieved.The quality of studies was assessed using the Jadad scale.Eligible studies were selected according to an established strategy.A meta-analysis was performed by the Stata software version 12.0.Results A total of 14 RCTs or CCTs were eligible for this meta-analysis,including five high-quality trials.Response rate ratios were calculated for ceftriaxone-treated patients compared with penicillin-treated patients.The meta-analysis showed no significant difference in the efficacy between ceftriaxone and penicillin at 6-,12-and 24-month follow-up visits.The response rate was 92.3％ (95％ CI:88.5％-96.1％) and 90.4％ (95％ CI:87.4％-94.4％) in ceftriaxone-and penicillintreated patients respectively at the 12-month follow-up visit.Funnel plots were approximately symmetrical,indicating little publication bias.Conclusions Ceftriaxone may serve as an alternative treatment for early syphilis with reliable efficacy.However,multi-centered RCTs with large sample sizes are still needed to optimize the therapeutic dose and course of ceftriaxone for early syphilis.

Objective To investigate the trends in and characteristics of syphilis epidemiology in China,and to provide a scientific basis for the development of control strategies.Methods An epidemiological study was performed on syphilis cases reported from 31 provinces,autonomous regions and municipalities between 2000 and 2013.Results The reported syphilis incidence increased yearly from 6.43 per 100 000 person-years in 2000 to 32.86 per 100 000 person-years in 2013,with an average annual growth rate of 13.37％.Syphilis was reported in most (99％) counties/districts in China mainland except for a few remote mountain areas,with a significant difference in the incidence of syphilis between different regions.The regions with a high incidence of syphilis included minority areas in Northwest China (Xinjiang,Qinghai and Ningxia),Minjiang River area,Yangtze River Delta (Zhejiang,Shanghai),Zhujiang River Delta (Guangxi,Guangdong),etc.There had been a rapid increase in the incidence of syphilis in some regions previously reported to have a low incidence (such as Guizhou,Shaanxi,Henan,etc).Among the reported cases,female patients predominated with an average male/female ratio of 0.92 ∶ 1.The incidence of syphilis was highest in the age group of 20-39 years,but increased yearly by more than 30％ in the population aged ＞ 60 years.Of 20 occupations,peasant workers accounted for the highest proportion (31.56％) of syphilis cases,and retired population showed the most rapid increase by about 27.35％ per year.The constituent ratio of primary and secondary syphilis in all the syphilis cases had declined yearly,while that of latent syphilis increased by more than 50％ after 2010.Conclusions Syphilis remains a major public health issue in China,and measures based on the epidemiological features are urgently needed to effectively control epidemic syphilis.

Objective To investigate epidemiological characteristics and trends of gonorrhea in China, and to provide a scientific basis for the development of control strategies. Methods An epidemiological study was performed on gonorrhea cases reported from 31 provinces, autonomous regions or municipalities directly under the central government between 2000 and 2014. Results The reported incidence rate of gonorrhea decreased from 22.92 per 100 000 in 2000 to 7.25 per 100 000 in 2014, with the average annual rate of decrease being 7.89%. There was a significant difference in the incidence of gonorrhea between different regions. The regions with the highest incidence rate of gonorrhea were Yangtze River Delta region(Zhejiang, Shanghai, Jiangsu)and Zhujiang River Delta region(Guangdong, Guangxi, Hainan), followed by northwest China (Xinjiang, Ningxia, Inner Mongolia). The incidence of gonorrhea was higher in males than in females, and the average male/female ratio increased from 1.96 ∶ 1 in 2000 to 4.52 ∶ 1 in 2014. The population aged 20 - 44 years showed high incidence of gonorrhea, and the highest incidence rate of gonorrhea was observed in the age group 25 - 29 years in both men and women. The incidence of gonorrhea decreased in all the age groups from 2000 to 2014 except the age group 15 - 19 years with an annual growth rate of 4.18%. Of 20 occupations, peasant workers accounted for the highest proportion (26.00%)of reported gonorrhea cases, and the number of reported gonorrhea cases showed a decreasing trend in all the occupations. Conclusions Gonorrhea remains a major public health issue in China, and effective measures based on epidemiological features are urgently needed to control gonorrhea.

Objective To investigate epidemiologic features of genital Chlamydia trachomatis (Ct) infection in China,and to provide scientific evidence for developing control strategies.Methods A descriptive epidemiological study was conducted to analyze personal,spacial and temporal distribution of genital Ct infection cases reported from 105 national sexually transmitted disease (STD) surveillance sites in China between 2008 and 2015.Results The reported incidence rate of genital Ct infection increased from 32.48 per 100 000 in 2008 to 37.18 per 100 000 in 2015,with the average annual rate of increase being 1.95％.There was marked variation in the reported incidence of genital Ct infection (range,＜ 1/100 000-615.99/100 000) among different STD surveillance sites,which was relatively high in the Pearl River Delta region,Yangtze River Delta region,Minjiang River region and some ethnic minority areas in western China,but low in north China and central China.In addition,no cases were reported at a few sites in rural areas.The reported annual incidence rate was higher in females than in males from 2008 to 2015,and the ratio of male to female cases decreased from 0.61:1 in 2008 to 0.46:1 in 2015.Among all age groups,the sexually active population aged 20-44 years showed high reported incidence of genital Ct infection,with the highest reported incidence observed in the group aged 25-29 years (range,116.72/100 000-142.98/100 000);the group aged 15-19 years showed the highest average annual rate of increase (10.06％) in the reported incidence of genital Ct infection.Among all kinds of medical institutions,general hospitals had the largest number of reported cases (range,66.00％-74.22％),followed by gynecology hospitals,Maternal and Child Health (MCH) hospitals and specialized dermatovenereology hospitals.Conclusions Genital Ct infection has been one of important public health issues in China,more attention should be paid to its prevention,and effective preventive measures are needed to be developed according to epidemiologic features.