Syphilis epidemic in China

A range of unique biological and social forces are driving a substantial syphilis epidemic in China, according to the results of a national surveillance programme published in this week’s issue of The Lancet.

Syphilis infection can have devastating health consequences, including acute cutaneous manifestations such as genital ulcers, chronic severe and debilitating compromise of the cardiovascular and nervous systems, and serious effects on reproductive and neonatal health.

During the first half of the 20th century, China experienced one of the biggest syphilis epidemics in human history. But the introduction of mass screening, free treatment, and the closure of brothels was highly effective, and resulted in the virtual elimination of syphilis and STDs by the 1960s, and for the next 20 years. However, long-term control of syphilis has proved difficult, and recent sporadic reports have provided clues to the magnitude of the spread of syphilis throughout China.

To investigate, Xiang-Sheng Chen (National Center for STD Control, Chinese Academy of Medical Sciences and Peking Union Medical College Institute of Dermatology, Nanjing, China) and colleagues calculated the incidence of syphilis throughout China by collecting and assessing case report data from China’s national STD surveillance system. They found that after remaining just below 0.2 cases per 100 000 people from 1989 to 1993, the total incidence of syphilis increased from 0.17 cases per 100 000 in 1993 to 6.5 cases per 100 000 in 1999. Between 2000 and 2005, the average incidence of primary and secondary syphilis was 5.13 cases per 100 000 people per year.

The investigators also found a very rapid rate of increase in the incidence of congenital syphilis, with an average yearly increase of 71.9%, from 0.01 cases per 100 000 livebirths in 1991 to 19.68 cases per 100 000 livebirths in 2005.

The authors suggest that this worsening syphilis epidemic is the result of the re-emergence of sex work, changing sexual practices, inadequate access of high risk populations to healthcare due to social stigma, and poor quality and prohibitive cost of the services well as a lack of herd immunity.

China has once before shown that the control of syphilis is possible, and the authors urgently call for a new national campaign of affordable syphilis screening and treatment.