Wang et al. BMC Public Health 2011, 11:955 http://www.biomedcentral.com/1471-2458/11/955 Table 3 Sexual Behavior of the Male STD Clinic Patients Characteristics Condom use frequency with regular sex partner Never Sometimes Always Yes Yes No Yes Yes No Yes No Yes No Yes No Homosexual/bisexual IDU in the last 6 months Condom use with regular sex partner last time No Whether visiting FSW in the last three months Condom usage with FSW last time No Whether had casual sexual partner in the last three months Condom usage with casual sexual partner last time % (No.) or Indicated Value Page 5 of 8 45.5 (1100/2416) 48.9 (1182/2416) 5.5 (134/2416) 24.8 (579/2412) 75.2 (1815/2412) 46.2 (1320/2886) 53.8 (1556/2886) 31.8 (419/1319) 68.2 (900/1319) 25.7 (736/2865) 74.3 (2129/2865) 30.1 (228/757) 69.9 (529/757) 0.9 (26/2865) 97.3 (2839/2865) 0.5 (15/2902) 99.5 (2887/2902) care providers may have occurred due to the common practices of self-treatment or visiting pharmacies for treatment of suspected gonorrhea in people with high risk sexual behaviors. Syphilis prevalence (10.7%) in China greatly exceeds most other reports in developed countries and India [23-25]. However, the prevalence is comparable to recent studies among STD clinic attendees in the Guangxi province (11.9%), and the Guizhou and Anhui (11.6%) provinces in China [7,26]. Additionally, in our study, syphilis prevalence was not distributed equally across these provinces. The highest prevalence of syphilis was found in Jiangsu (19.4%), followed by Guangdong (8.8%), Guangxi (6.0%), and Hainan (4.3%) provinces. The highest gonorrhea infection rate was also found in Jiangsu province. This difference is probably due to sociocultural and economic determinants. Jiangsu had a GDP per capita of $6,475 USD in 2010, exceeded the other 3 investigating provinces. It has been shown that the highest incidences of STDs are in China’s wealthiest areas [27]. C. trachomatis prevalence has been studied in several areas of the world, with the prevalence rate among STD clinics varying from 4.6% in Jordan to 13.1% in Brazil [28,29]. With a much higher syphilis positive rate than C. trachomatis rate in our study, the STD pat- tern in China is different from others areas [30]. These results strongly support syphilis screening for every STD clinic attendee, which is highlighted in China’s Plan for Syphilis Prevention and Control (2010-2020). The high STD prevalence alongside low condom use rates among these clinic attendees emphasizes the grav- ity of China’s STD/HIV epidemic. Only a few partici- pants (2.2%, 65/2933) had ever been offered partner notification services. Partner notification and treatment are important parts of a STD control strategy as one of the few available means of reaching individuals with asymptomatic STDs. Partner notification is also an opportunity for health education and promotion of con- dom use, and should be initiated and strengthened in STD clinics [31]. Overall, 21(0.7%) patients were found to be HIV posi- tive. There was considerable geographical variation in HIV prevalence, ranging from 0% in Guangdong and 0.1% in Hainan to 0.6% in Jiangsu and 1.8% in Guangxi. According to the AIDS Prevalence Report of the China