Factors Associated with Sexually Transmitted Infection Underreporting Among Female Sex Workers in China

Objective: To examine the underreporting of sexually transmitted infections (STI) (i.e., no STI by self-report but have at least one SIT through biological testing or clinical examination) and factors associated with underreporting among female sex workers (FSWs) in China. Methods: A total of 454 FSWs were recruited from entertainment establishments in a rural county of Guangxi, China. Participants completed a self-administered survey about their demographic and working characteristics, history of STI (past or current infections), sexual history and practices, and HIV/STI-related knowledge and perceptions; 411 of the sample were also tested for syphilis, Neisseria gonorrheae, Chlamydia, Trichomonas, and genital warts. Results: About 18% (79 of 411) of the sample reported a history of STI (past or current infections). Biological testing or clinical examination revealed at least one SIT (acute SIT) for 42% (171 of 411) of the sample. Only 9% (37 of 411) of FSWs with acute STI reported an STI through self-report, which resulted in 33% (134 of 411) of FSWs who were considered underreporting their STI. STI underreporting was independently associated with younger age (adjusted odds ratio [aOR] 0.87, 95% confidence interval [CI] 0.76-0.99), a shorter duration of commercial sex (aOR 0.97, 95% CI 0.94-0.99), poorer knowledge of SIT (aOR 0.81, 95% CI 0.70-0.94), and less sexual risks (aOR 0.52, 95% CI 0.41-0.66). Conclusions: Underreporting of SIT was prevalent in FSWs, especially among women with perceived lower STI risks. The underreporting might be largely due to their perception of low risks for SIT and unawareness of SIT symptoms (including asymptomatic STIs). Future studies of FSWs should identify those new in commercial sex with lower SIT awareness and perceived risks and encourage them to seek timely and appropriate testing and treatment.