karaoke bars or hotels) are usually disproportionately recruited.
In this case, the FSWs working at luxurious sex venues (e.g. Freelance FSWs are usually not included in the surveillance of most sentinel sites. Based on a list of establishments which are typically used for interventions through outreach work, some venues are selected for recruiting a convenience sample of FSWs for a questionnaire survey and specimen collection. Current sentinel surveillance for HIV and syphilis infections among FSWs in China is usually based on recruitment of a convenience sample of FSWs working in entertainment establishments. However, case report data may underestimate the true burden of syphilis due to inadequate screening among asymptomatic infected persons and underreporting of the diagnosed cases. The reported incidence of primary and secondary syphilis (reflecting the intensity of recent transmission) was 11.7 cases per 100, 000 residents in 2009, which had increased by 2.1 times since 2005. Syphilis prevalence monitoring among specific high-risk populations including FSWs is conducted through HIV sentinel surveillance surveys to provide trends for gauging the effectiveness of prevention efforts.
Syphilis surveillance in China has relied largely on case reports submitted by hospitals or clinics through a website-based case-reporting system. Assessing the disease burden of syphilis among FSWs is necessary for planning primary and secondary prevention control measures. Thus, the syphilis epidemic holds important relevance for infectious disease burden control in China and the region. Syphilis has been ranked as the third most prevalent notifiable infectious disease in China. Female sex workers (FSWs) are more at risk of having HIV, syphilis and other sexually transmitted infections (STIs). Syphilis has been considered as one of factors to facilitate HIV transmission. Heterosexual contacts have become one of primary modes of HIV transmission in China. Syphilis has made a dramatic resurgence in China during the past two decades.
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