Xiang-Sheng Chen

University of North Carolina at Chapel Hill, Chapel Hill, NC, United States

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Publications (76)375 Total impact

  • [show abstract] [hide abstract]
    ABSTRACT: Background. Epidemic of HIV and syphilis among MSM are major public health concerns in most parts of China. Dearth of information regarding the current trend of HIV in this hard-to-reach population in several regions including Jiangsu coupled with the re-emergence of syphilis called for an effort to understand the dynamics of the dual epidemic in this province. Methods. To estimate the occurrence and burden of these two sexually transmitted diseases and the distribution of their potential socio-behavioral correlates among MSM in Jiangsu, two cohort studies were conducted in Yangzhou and Changzhou cities. Results. Among total 839 participants, 48% were married, 51.7% had sex with women in last 6 months and 25.5% did not use condom during their last anal intercourse. The observed incidence of HIV was 13.59 & 12.62 and syphilis was 7.33 & 13.25 per 100 person-years among the participants of n Yangzhou and Changzhou respectively. The baseline prevalence of HIV and Syphilis were 16.0% and 29.9% in Yangzhou and 13.6% and 14.9% in Changzhou respectively. Conclusion. Considerably high incidence and prevalence of HIV and syphilis among participants and their potential bridging role in transmitting these infections to general population in Yangzhou and Changzhou cities thus called for urgent effective intervention strategies.
    Clinical Infectious Diseases 03/2014; · 9.37 Impact Factor
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    ABSTRACT: Although Mycoplasma genitalium (MG) is a common sexually transmitted infection (STI), very little information regarding the prevalence of MG among MSM (men who have sex with men) is available in China. The objective of this study was to determine the prevalence of MG among MSM in the city of Shenzhen, Guangdong Province, China, and to identify the potential risk factors associated with MG infection in this population. Between January and May 2010, a total of 409 MSM were recruited in Shenzhen, Guangdong Province, China. An anonymous questionnaire was used to collect information regarding their sociological and sexual behaviors. In addition, their first-void urine (FVU) samples and rectal swabs were collected for PCR-based MG testing. Among the 406 FVU and 405 rectal swab samples were collected from 409 MSM, the overall MG prevalence was 8.1% (33/406, 95% CI 5.7%-10.6%), with a FVU positivity of 3.4% (95% CI 1.7%-5.4%) and a rectal positivity of 5.4% (95% CI 3.5%-7.7%). Using both univariate and multivariable logistic regression analyses, urethral MG infection was significantly associated with having more heterosexual behaviors (AOR 7.16, 95% CI 1.89-27.13,) and with having unprotected anal intercourse in the past six months (AOR 4.80, 95%CI 1.40-16.47). Rectal MG infection was significantly associated with HIV infection based on univariate logistic regression analysis (OR = 4.49, 95% CI 1.18-17.12). In this study, we investigated the prevalence of MG infection in the population of interest, as determined from both urethral and rectal specimen. We showed that MG was more prevalent in MSM who had bisexual behaviors compared to those who engaged only in homosexual behaviors. Further work is needed to establish the mode of MG transmission and to identify its role in HIV transmission. Meanwhile, more attention should be paid to MG infection among MSMs, and especially bisexual MSMs, which might have critical implications for effective HIV/STD control in China.
    BMC Public Health 02/2014; 14(1):195. · 2.08 Impact Factor
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    ABSTRACT: Despite widespread biomedical advances in treatment and prevention, HIV and other sexually transmitted infections (STI) continue to affect a large portion of the world's population. The profoundly social nature of behaviorally driven epidemics and disparities across socioeconomic divides in the distribution of HIV/STI and care outcomes emphasize the need for innovative, multilevel interventions. Interdisciplinary approaches to HIV/STI control are needed to combine insights from the social and biological sciences and public health fields. In this concluding essay to a Special Issue on HIV/STI in south China, we describe the evolution of the region's HIV/STI epidemics and the government response, then synthesize findings from the 11 studies presented in this issue to extend seven recommendations for future HIV/STI prevention and care research in China. We discuss lessons learned from forging international collaborations between the social and biological sciences and public health to inform a shared research agenda to better meet the needs of those most affected by HIV and other STI.
    AIDS and Behavior 01/2014; · 3.49 Impact Factor
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    ABSTRACT: To estimate the prevalence of sexually transmitted infections (STIs) among female sex workers (FSWs) in the Jiangsu Province, China and measure the association of Chlamydia trachomatis (CT) and Neisseria gonorrhoeae (NG) infections with their potential correlates. A cross-sectional study on a representative sample of FSWs in Yangzhou and Changzhou cities of Jiangsu was conducted. 185 sex-work venues in Yangzhou and 174 in Changzhou were selected by stratified random sampling. 2972 FSWs (1108 in Yangzhou and 1864 in Changzhou), aged 15 years or more, who agreed to participate and provided blood sample for HIV and syphilis testing were interviewed in these venues. Cervical specimens from 849 randomly chosen participants were then tested for CT and NG. Proportions of young, school-educated, currently married FSWs who were living alone, migrated from other provinces and engaged in unprotected vaginal intercourse in past 3 months (UVI) were relatively high. Prevalence of HIV, syphilis, CT and NG were 0.20%, 4.88%, 14.61% and 5.42% respectively. Younger age, living alone or with persons other than partners/family members, engaging in UVI and having other STIs seemed to be associated with higher risk of CT or NG infection. Being divorced/widowed and working in middle/low-level venues were identified as additional risk factors for NG. Based on a representative sample, this initial effort to identify the correlates of CT/NG infections among FSWs of Jiangsu revealed that focused interventions targeting high-risk FSWs are urgently required for controlling STI epidemics in Yangzhou and Changzhou where substantial number of STI cases were identified.
    PLoS ONE 01/2014; 9(1):e85985. · 3.73 Impact Factor
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    ABSTRACT: To evaluate the performance of the Abbott RealTime CT/NG assay for detection of Chlamydia trachomatis (CT) and Neisseria gonorrhoeae (NG) among female sex workers (FSWs) in China. Cervical swabs from 997 participants were blindly detected by the Abbott RealTime CT/NG assay on the automated m2000 molecular platform and Roche Cobas Amplicor CT/NG assay. Discrepant analysis were confirmed by the Qiagen care CT PCR assay. The sample was defined as candidate nvCT-positive if it was CT positive in the Abbott m2000 assay, but CT negative in the other two assays. 25 specimens that were discordant for CT and 26 specimens that were discordant for NG between the two assays were resolved by Qiagen care CT & NG PCR assays. The sensitivity and specificity, respectively, for Abbott m2000 assay were 92.59% and 100% for CT and 95.45% and 99.90% for NG. The positive predictive value (PPV) and negative predictive value (NPV) of Abbott m2000 assay were100% and 98.52% for CT and 95.5% and 99.90% for NG, respectively. No candidate new-variant CT(nvCT)specimens were identified. Abbott RealTime CT/NG assay were more specify for CT and NG detection, however, its sensitivity for CT and NG were a little bit lower than Roche Cobas Amplicor CT/NG assay. Abbott RealTime CT/NG assay had higher PPV for NG detection than Roche Cobas Amplicor CT/NG assay; it would be more suitable for screening for population with low-prevalence NG. There is currently no evidence that nvCT is present in FSWs in China.
    PLoS ONE 01/2014; 9(3):e89658. · 3.73 Impact Factor
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    ABSTRACT: The objective of this study was to determine the prevalence of urethral Mycoplasma genitalium infections among male patients attending a sexually transmitted disease (STD) clinic in China and identify risk factors associated with this disease. A total of 423 patients were recruited in Hezhou City, Guangxi Province, China, and each was requested to complete a questionnaire regarding sociological and sexual behaviors. First-void urine samples were collected for M. genitalium analysis by polymerase chain reaction. Of the 406 urine samples collected, 114 were M. genitalium-positive, giving a prevalence rate of 28.1%. Univariate logistic regression analysis showed that M. genitalium infection was associated with younger age, having received at least senior high school education, and single marital status. In both univariate and multivariate logistic regression analyses, M. genitalium infection was found to be associated with lack of symptoms for STD in the past year (adjusted odds ratio [AOR] = 2.839; 95% CI = 1.495-5.392; P = 0.001), no use of condoms with steady partners in the past year (AOR = 2.830; 95% CI = 1.468-5.455; P = 0.002), and having sexual encounters with female sexual workers within the past 3 months (AOR = 2.955; 95% CI = 1.637-5.336; P < 0.0003). The observed high rate of M. genitalium infection among male STD patients in Hezhou City indicates an M. genitalium epidemic in the study population; thus, the national surveillance program and clinical health providers in China should more closely monitor this disease.
    Japanese journal of infectious diseases. 01/2014; 67(1):17-21.
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    ABSTRACT: Brief non-commercial sexual encounters among patrons of social venues are increasing in China, but whether these encounters increase syphilis risk is unknown. We surveyed and tested 797 men and women at randomly selected social venues in urban Liuzhou and three surrounding counties. The percent reporting recent non-commercial one-time sex ranged from 14.5 % of county women to 24.8 % of urban men. 2.4 % of men and 3.7 % of women had a positive rapid syphilis test. Men reporting non-commercial one-time sex were significantly more likely to have a positive rapid syphilis test than other men (7.4 vs. 0.9 %). Among women, commercial sex was more strongly associated with syphilis than non-commercial one-time sex (6.0 vs. 0.7 %). Recent one-time sex was common and associated with syphilis among men. Venue-based HIV/STI prevention methods may be warranted among persons who do not engage in commercial sex, but frequently engage in one-time sex.
    AIDS and Behavior 11/2013; · 3.49 Impact Factor
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    ABSTRACT: This study aimed to investigate the prevalence of penicillinase-producing Neisseria gonorrhoeae (PPNG) and their blaTEM-135 gene variant in 2007 and 2012 in Nanjing, China. In addition, molecular epidemiological typing of all isolates was performed to elucidate the genetic relationships of the PPNG strains. A total of 199 and 77 N. gonorrhoeae isolates were collected at the National Center for STD Control in 2007 and 2012, respectively. Nitrocefin tests were performed to identify PPNG. Mismatch amplification mutation assay was used to identify blaTEM-135. All isolates were genotyped using N. gonorrhoeae multiantigen sequence typing (NG-MAST), and additionally, porB-based phylogenetic analysis was performed for the PPNG isolates. The total prevalence of PPNG isolates was 41% (114/276) and 58% (66/114) of these PPNG isolates possessed blaTEM-135. In 2007, 45% (90/199) produced β-lactamase, and of those PPNG, 58% (52/90) possessed blaTEM-135. In 2012, 31% (24/77) were PPNG, and 58% (14/24) of those isolates contained blaTEM-135. There were 162 NG-MAST STs among the 276 isolates, and 89 of those were novel STs. A strong association between specific NG-MAST STs and blaTEM-135 was found, and the porB-based phylogenetic analysis showed a distant evolutionary relationship between isolates in 2007 and isolates in 2012. A high prevalence of PPNG and blaTEM-135 was found in Nanjing, China. blaTEM-135 might be a precursor in the evolution into an extended-spectrum β-lactamase that can degrade ceftriaxone, which stresses the need to continuously monitor PPNG, blaTEM-135, and additional evolving blaTEM gene variants.
    Sexually transmitted diseases 11/2013; 40(11):872-876. · 2.58 Impact Factor
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    ABSTRACT: The re-emerging syphilis epidemic in China is documented among sex workers, but little is known about STI risk among the broader group of women who work at entertainment and service venues, many of whom do not self-identify as sex workers. In 2009 in Liuzhou, China, community informants identified venues where people meet sexual partners. Characteristics of a stratified random sample of venues were collected during venue visits. Female staff at 42 venues were interviewed and tested for syphilis. The results showed that venue characteristics, worker behaviors, and syphilis prevalence differed by venue type. Service venue workers had more sexual partners, were more likely to report sex work, and more likely to have a positive syphilis test than entertainment venue workers (prevalence ratio: 5.4; 95 % CI 1.4-20.6). To conclude, risk of syphilis differs by venue type and is higher at service venues, even among women who do not report commercial sex.
    AIDS and Behavior 07/2013; · 3.49 Impact Factor
  • Xiang-Sheng Chen, Yue-Ping Yin, Qian-Qiu Wang, Bao-Xi Wang
    Chinese medical journal 07/2013; 126(14):2774-9. · 0.90 Impact Factor
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    ABSTRACT: A cross-sectional study that investigated the association between cervical infection of Chlamydia trachomatis, Neisseria gonorrhoeae, or Mycoplasma genitalium and infection with high-risk types of human papillomavirus among female sex workers in China found that the presence of cervical C. trachomatis or M. genitalium infection was independently associated with infection with certain high-risk types of specific high-risk human papillomavirus among this population.
    Sexually transmitted diseases 06/2013; 40(6):493-5. · 2.58 Impact Factor
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    ABSTRACT: BACKGROUND: Sexually transmitted infections (STIs) have become a major public health problem among female sex workers (FSWs) in China. There have been many studies on prevalences of HIV and syphilis but the data about Neisseria gonorrhoeae (NG) and Chlamydia trachomatis (CT) infections are limited in this population in China. METHODS: A cross-sectional study was performed among FSWs recruited from different types of venues in 8 cities in China. An interview with questionnaire was conducted, followed by collection of a blood and cervical swab specimens for tests of HIV, syphilis, NG and CT infections. RESULTS: A total of 3,099 FSWs were included in the study. The overall prevalence rates of HIV, syphilis, NG and CT were 0.26%, 6.45%, 5.91% and 17.30%, respectively. Being a FSW from low-tier venue (adjusted odds ratios [AOR]=1.39) had higher risk and being age of >= 21 years (AOR=0.60 for 21--25 years; AOR=0.29 for 26--30 years; AOR=0.35 for 31 years or above) had lower risk for CT infection; and having CT infection was significantly associated with NG infection. CONCLUSIONS: The high STI prevalence rates found among FSWs, especially among FSWs in low-tier sex work venues, suggest that the comprehensive prevention and control programs including not only behavioral interventions but also screening and medical care are needed to meet the needs of this population.
    BMC Public Health 02/2013; 13(1):121. · 2.08 Impact Factor
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    ABSTRACT: Syphilis is a major public health problem in many regions of China, with increases in congenital syphilis (CS) cases causing concern. The Chinese Ministry of Health recently announced a comprehensive 10-y national syphilis control plan focusing on averting CS. The decision analytic model presented here quantifies the impact of the planned strategies to determine whether they are likely to meet the goals laid out in the control plan. Our model incorporated data on age-stratified fertility, female adult syphilis cases, and empirical syphilis transmission rates to estimate the number of CS cases associated with prenatal syphilis infection on a yearly basis. Guangdong Province was the focus of this analysis because of the availability of high-quality demographic and public health data. Each model outcome was simulated 1,000 times to incorporate uncertainty in model inputs. The model was validated using data from a CS intervention program among 477,656 women in China. Sensitivity analyses were performed to identify which variables are likely to be most influential in achieving Chinese and international policy goals. Increasing prenatal screening coverage was the single most effective strategy for reducing CS cases. An incremental increase in prenatal screening from the base case of 57% coverage to 95% coverage was associated with 106 (95% CI: 101, 111) CS cases averted per 100,000 live births (58% decrease). The policy strategies laid out in the national plan led to an outcome that fell short of the target, while a four-pronged comprehensive syphilis control strategy consisting of increased prenatal screening coverage, increased treatment completion, earlier prenatal screening, and improved syphilis test characteristics was associated with 157 (95% CI: 154, 160) CS cases averted per 100,000 live births (85% decrease). The Chinese national plan provides a strong foundation for syphilis control, but more comprehensive measures that include earlier and more extensive screening are necessary for reaching policy goals. Please see later in the article for the Editors' Summary.
    PLoS Medicine 01/2013; 10(1):e1001375. · 15.25 Impact Factor
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    ABSTRACT: Health providers have played important roles on delivering prevention and care services to control syphilis in China. The current study was aimed to evaluate the performance of different health providers in providing outreach syphilis testing services to female sex workers (FSWs). The current study carried out during April to August 2009 in Liuzhou was aimed to investigate the services delivered by two different types of clinics in China. A total of 1,808 FSWs recruited from sex work venues were included in the study. Prevalence of positive syphilis test (6.4%) among FSWs accessed by the local center for disease control outreach teams (CDC teams) was significantly lower than that (9.3%) among FSWs accessed by the local reproductive health hospital outreach teams (RHH teams). As compared with CDC teams, RHH teams had more FSWs to be successfully referred to the designated STD clinics for further syphilis confirmation and intervention (85.7% vs. 26.7%, P<0.001). These findings indicate that RHH teams may be more efficient than CDC teams to provide outreach-based services to FSWs. Participation of the reproductive health providers or other medical facilities in outreach services to FSWs should be considered in developing intervention programs in China.
    PLoS ONE 01/2013; 8(4):e60626. · 3.73 Impact Factor
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    ABSTRACT: The objective of this study was to assess the distribution of Chlamydia trachomatis genovars in male sexually transmitted disease (STD) clinic patients from 1 province in eastern China (Jiangsu) and 3 provinces in southern China (Guangdong, Guangxi, and Hainan). Urine specimens (n = 140) were collected from 46 public STD clinics in the 4 provinces. Specimens that tested positive for C. trachomatis by polymerase chain reaction were genotyped for the infecting C. trachomatis strain by amplifying and sequencing the genovar-specific ompA gene, which encodes the chlamydial major outer-membrane protein. Nine C. trachomatis genovars were identified from 129 specimens; they consisted of the F (25.6%), E (17.1%), J (16.3%), D (15.5%), G (11.6%), K (5.4%), H (3.9%), I (1.6%), and B (0.8%) genovars. Nine genovars were found in specimens from Guangxi province, 6 were found in specimens from each of Guangdong and Hainan provinces, but only 5 were found in specimens from Jiangsu province. Genovar G/Ga was shown to be endemic among male patients in southern China.
    Japanese journal of infectious diseases. 01/2013; 66(1):69-71.
  • Xiang-Sheng Chen, Yue-Ping Yin, Ning Jiang
    The Lancet Infectious Diseases 01/2013; 13(1):13. · 19.97 Impact Factor
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    ABSTRACT: To determine the prevalence and correlates of syphilis among pregnant women in rural areas of South China. Point-of-care syphilis testing was provided at 71 health facilities in less developed, rural areas of Guangdong Province. Positive samples were confirmed at a local referral center by toluidine red unheated serum tests (TRUST) and Treponema pallidum particle agglutination (TPPA) tests. Altogether 27,150 pregnant women in rural Guangdong were screened for syphilis. 106 (0.39%) syphilis cases were diagnosed, of which 78 (73.6%) received treatment for syphilis. Multivariate analysis revealed that older pregnant women (31-35 years old, aOR 2.7, 95% CI 0.99-7.32; older than 35 years old, aOR 5.9, 95% CI 2.13-16.34) and those with a history of adverse pregnant outcomes (aOR 3.64, 95% CI 2.30-5.76) were more likely to be infected with syphilis. A high prevalence of syphilis exists among pregnant women living in rural areas of South China. Enhanced integration of syphilis screening with other routine women's health services (OB GYN, family planning) may be useful for controlling China's syphilis epidemic.
    PLoS ONE 01/2013; 8(8):e72149. · 3.73 Impact Factor
  • Sexually transmitted infections 12/2012; · 2.18 Impact Factor
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    ABSTRACT: To compare two methods for sampling female sex workers (FSWs) for bio-behavioural surveillance. We compared the populations of sex workers recruited by the venue-based Priorities for Local AIDS Control Efforts (PLACE) method and a concurrently implemented network-based sampling method, respondent-driven sampling (RDS), in Liuzhou, China. For the PLACE protocol, all female workers at a stratified random sample of venues identified as places where people meet new sexual partners were interviewed and tested for syphilis. Female workers who reported sex work in the past 4 weeks were categorised as FSWs. RDS used peer recruitment and chain referral to obtain a sample of FSWs. Data were collected between October 2009 and January 2010. We compared the socio-demographic characteristics and the percentage with a positive syphilis test of FSWs recruited by PLACE and RDS. The prevalence of a positive syphilis test was 24% among FSWs recruited by PLACE and 8.5% among those recruited by RDS and tested (prevalence ratio 3.3; 95% CI 1.5 to 7.2). Socio-demographic characteristics (age, residence and monthly income) also varied by sampling method. PLACE recruited fewer FSWs than RDS (161 vs 583), was more labour-intensive and had difficulty gaining access to some venues. RDS was more likely to recruit from areas near the RDS office and from large low prevalence entertainment venues. Surveillance protocols using different sampling methods can obtain different estimates of prevalence and population characteristics. Venue-based and network-based methods each have strengths and limitations reflecting differences in design and assumptions. We recommend that more research be conducted on measuring bias in bio-behavioural surveillance.
    Sexually transmitted infections 12/2012; 88 Suppl 2:i95-i101. · 2.18 Impact Factor
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    ABSTRACT: Background. Rapid point-of-care (POC) syphilis tests based on simultaneous detection of treponemal and non-treponemal antibodies (dual POC tests) offer the opportunity to increase coverage of syphilis screening and treatment. This study aimed to conduct a multi-site performance evaluation of a dual POC syphilis test in China.Methods. Participants were recruited from patients at STD clinics and high-risk groups in outreach settings in six sites in China. Three kinds of specimens (whole blood, WB; finger prick blood, FB; and blood plasma, BP) were used for evaluating sensitivity and specificity of the Dual Path Platform (DPP) test using its treponemal (T1) and non-treponemal (T2) lines to compare Treponema pallidum particle agglutination (TPPA) and toluidine red unheated serum test (TRUST) as reference standards.Results. A total of 3134 specimens (WB 1323, FB 488, and BP 1323) from 1323 individuals were collected. The sensitivities as compared with TPPA were 96.7% for WB, 96.4% for FB, and 94.6% for BP; and the specificities were 99.3%, 99.1%, and 99.6%, respectively. The sensitivities as compared with TRUST were 87.2% for WB, 85.8% for FB, and 88.4% for BP; and the specificities were 94.4%, 96.1% and 95.0%, respectively. For specimens with a TRUST titer of 1:4 or higher, the sensitivities were 100.0% for WB, 97.8% for FB, and 99.6% for BP, respectively.Conclusion. DPP test evaluated shows good sensitivity and specificity in detecting treponemal and non-treponemal antibodies in three kinds of specimens. It is hoped that this assay can be considered as an alternative in the diagnosis of syphilis, particularly in resource-limited areas.
    Clinical Infectious Diseases 11/2012; · 9.37 Impact Factor

Publication Stats

647 Citations
375.00 Total Impact Points


  • 2012–2013
    • University of North Carolina at Chapel Hill
      • Carolina Population Center
      Chapel Hill, NC, United States
    • London School of Hygiene and Tropical Medicine
      Londinium, England, United Kingdom
    • Chinese Center For Disease Control And Prevention
      Peping, Beijing, China
    • Peking Union Medical College Hospital
      Peping, Beijing, China
  • 2010–2013
    • Chinese Academy of Medical Sciences
      Peping, Beijing, China
    • Guangzhou Center for Disease Control
      Shengcheng, Guangdong, China
    • Johns Hopkins Bloomberg School of Public Health
      Baltimore, Maryland, United States
  • 2011–2012
    • China Academy of Chinese Medical Sciences
      Peping, Beijing, China
    • Jiangsu Provincial Center for Disease Control and Prevention
      Chiang-tu, Jiangsu Sheng, China
  • 2010–2012
    • Partners HealthCare
      Boston, Massachusetts, United States
  • 2010–2011
    • Massachusetts General Hospital
      • Division of Infectious Diseases
      Boston, MA, United States
  • 2007
    • University of California, San Francisco
      San Francisco, California, United States
    • Qingdao University
      Tsingtao, Shandong Sheng, China