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China experiencing a dramatic reemergence of syphilis
Although China eradicated syphilis in the 1960s, a new national campaign may now be needed to combat the disease.
The resurgence of syphilis in China has increased to an epidemic level that now calls for immediate intervention, according to a study published in a recent issue of The Lancet.
Myron S. Cohen, MD, director of the Center for Infectious Diseases at the University of North Carolina at Chapel Hill School of Medicine, and colleagues analyzed data from China’s sexually transmitted diseases surveillance system and sentinel site network. “Syphilis has returned to China with a vengeance,” Cohen said. “The data demonstrate a syphilis epidemic of such scope and magnitude that will require terrific effort to intervene.”
Total syphilis cases in China increased from less than 0.2 cases per 100,000 people between 1989 and 1993 to 6.5 cases per 100,000 in 1999. Congenital syphilis cases increased from 0.01 cases per 100,000 live births in 1991 to 19.68 cases per 100,000 live births in 2005.
In the 1950s, syphilis was seen in about 5% of the general population in China, but was eradicated a decade later. However, the first few cases after eradication were reported in 1979. Syphilis may have reemerged because of economic reforms, such as China’s growth and globalization, sexual practices, a reduction of governmental emphasis on public health services and increasing costs of health care. Cohen said other factors may include the risk of sex work, a surplus of men and massive migration across China.
Increased syphilis cases
More than 70% of syphilis cases in China within the past 10 years consisted of people aged 20 to 49. The average age of people with syphilis in China was 37.6 years. Higher average ages were located in the northern and central parts of the country. The ratio of men and women who have syphilis decreased from 2:0 to 1:0 between 1988 and 2000, and remain the same.
In the past five years, all 2,882 counties in China reported cases of syphilis. In 2005, the highest number of total cases was reported in Shanghai (55.3 cases per 100,000 people), Zhejiang (35.9 cases per 100,000 people) and Fujian (26.8 cases per 100,000 people).
Primary and secondary syphilis cases were higher in 2005 than in most developed countries, such as the United States (5.67 cases vs. 2.7 cases per 100,000 people).
The researchers conducted a review of a study from Sexually Transmitted Diseases regarding the prevalence of syphilis in specific populations. The previous study stated that syphilis appeared in 0.45% of antenatal women, 0.66% of premarital testing, 0.37% in voluntary blood donors, 1.4% in migrant workers, 2.86% in remunerated blood donors, 0.83% in possible female sex workers, 12.49% in incarcerated female sex workers, 6.81% in drug users and 14.6% in men who have sex with men.
Cohen and colleagues found that within the past five to 10 years, the number of syphilis cases increased by 0.96% per year for drug users, 1.41% per year for incarcerated female sex workers and 4.5% per year for men who have sex with men.
Possible solutions
According to the researchers, affordable screening for syphilis must be made available in order for China to quell the spread of syphilis. The researchers suggested that free syphilis screening should be provided for people who have a higher likelihood of contracting syphilis, such as female sex workers and men who have sex with men. “Syphilis testing is absolutely essential for pregnant women, risk groups and people with STDs and HIV,” Cohen said. Currently, health centers in China provide free counseling and HIV testing, including the city of Shenzhen that provides free syphilis screening for pregnant women.
“The biggest issue now is intervention. The beginning [of eradication] must focus on prevention of infection in mothers and their children,” Cohen said. – by Pam Rothman
For more information:
- Chen ZQ, Zhang GC, Gong ZD. Syphilis in China: results of a national surveillance program. Lancet. 2007;369:132-138.
- Lin CC, Gao X, Chen XS, et al. China’s syphilis epidemic: a systemic review of seroprevalence studies. Sex Transm Dis. 2006;33:726-736.