PONE-D-20-07301

Prevalence and risk factors of asymptomatic Neisseria gonorrhoeae and Chlamydia trachomatis infections in Shenzhen, China: a cross-sectional study.

PLOS ONE

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Reviewers' comments:

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Comments to the Author

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Reviewer #1: Partly

Reviewer #2: Yes

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Reviewer #1: Yes

Reviewer #2: Yes

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Reviewer #1: No

Reviewer #2: No

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Reviewer #1: No

Reviewer #2: Yes

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5. Review Comments to the Author

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Reviewer #1: Thank you for the opportunity to review your interesting and important research

Major comments

1. The aim of the study was to determine prevalence of asymptomatic Chlamydia trachomatis and Neisseria gonorrhoeae infections and the risk factors associated with these infections. However, as the authors have already conceded that due to low a prevalence of N. gonorrhoeae in their study, the number of C. trachomatis and N. gonorrhoeae cases were combined therefore the risks factors associated with asymptomatic infection of each pathogen could not be independently determined. Could you discuss in your limitations the implications of this? I think the title of the study in that regard does not address the aims as the risk factors associated with asymptomatic C. trachomatis and N. gonorrhoeae were not independently determined in this study.

2. The authors determined one the risk factors for asymptomatic C. trachomatis / N. gonorrhoeae was recruitment from urology department (men) and dermatology (men). Did you include results from the other 46 departments in your analysis? In your results in Table 3 and 5 data from only three departments is shown.

3. Results in table 2 and table 3 should also include the actual number of positive C. trachomatis and N. gonorrhoeae cases not just as “positive cases”

Minor comments

Line 42 and 80: “Chlamydia trachomatis” and “Neisseria gonorrhoeae” should always be in italics

Line 82: can you cite a more recent reference with up-to-date epidemiological information

Line 86: please add a reference to support mentioned statements

Line 150: “magnetism” should be “magnetic”

Line 264: “but these two diseases (especially CT)” please rephrase as CT and NG are bacterial names not diseases

Results: were there any participants with dual C. trachomatis or N. gonorrhoeae infections?

Reviewer #2: Asymptomatic infection is the main source of STIs. The results of this study are interesting for readers to understand the burden and characteristics of asymptomatic gonorrhea and chlamydia infection in Shenzhen, as well as for the formulating corresponding control strategies. In general, this is a good-writing manuscript with interesting findings.

The following suggestions for your considering in your revision.

１. Please clarify the selection process: Are these 6 districts reported more cases than the 4 who were not selected?(Line 121: First, we selected 6 out of the 10 administrative districts in Shenzhen based on the number of NG and CT cases reported in 2017)．

２. Please clarify the enrollment: (Line 127)The first 15 eligible individuals who arrived at each department were invited…… ), this is confusing, I guess should be “the first 15 eligible individual every working day” to participate in the questionnaire survey and urine collection

３. Definition of symptoms, as this is quite important and easy to cause bias. From the results, it seemed that symptomatic or asymptomatic were self-reported, the question is who made the judgement? Is any case or all cases examined by doctors? As patients may reported symptom-free, while doctor found urethral discharge during physical examination. In addition, urethritis or cervicitis are clinical diagnosis, and should be judged by clinical examination, please clarify this.

４. Please delete the repeated sentence: Line 181: The proportion of asymptomatic urethral NG in men with urethral NG was 7.2%; for women it was 16.3%. The proportion of asymptomatic

５. In the results, a table which describe the characteristics of all participants will add more information to readers.

６. Table 1 is confusing, will be clearer to have: number of total tested, number of positive in total; number of asymptomatic, number of positive among asymptomatic, this could be further stratified by sex.

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Reviewer #1: No

Reviewer #2: None

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Attachments

Attachment

Submitted filename: Chang et al reviewers comments PLOSONE.docx

Cross-sectional study of asymptomatic Neisseria gonorrhoeae and Chlamydia trachomatis infections in sexually transmitted disease related clinics in Shenzhen, China

PONE-D-20-07301R1

Dear Dr. Cai,

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With kind regards,

Remco PH Peters, MD, PhD, DLSHTM

Academic Editor

PLOS ONE

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