Syphilis Returns to China … With a Vengeance

Abstract

Syphilis was first recognized in China in the 1500s and was most likely brought to China by Portuguese traders. By the time of the liberation of China in 1949 syphilis was one of the most common causes for medical care and prevalence surveys revealed a massive epidemic in sex workers and national minority populations. The Chinese Communist government made treatment and prevention of syphilis a priority and inspired a prolonged and successful but draconian campaign to accomplish this goal. By 1964 syphilis was very rare and the infection was probably virtually eliminated until China opened its international borders to Western tourists and commerce in the early 1980s. The first resurgent cases of syphilis were recognized in China in 1979 and a national surveillance system has demonstrated a steady and disturbing spread of the disease throughout the country. In this issue of STD 2 articles address this situation. First Lin et al review the Chinese and English literature since 2000 in an attempt to better estimate the magnitude of the syphilis epidemic. The results suggest that syphilis infections are currently being detected at relatively low prevalence (0.2-0.7%) in the general population and antenatal screening clinics but at much greater prevalence in high-risk populations. Syphilis was detected in 3% to 11% of sex workers (a sad reminder of the pre-Mao past) and 10% to 18% of men reporting sex with men (MSM). A substantial rise in yearly prevalence was noted in all groups studied reaching a 4.4% yearly increase in MSM. The rapid spread of syphilis in MSM in China is also being observed in gay communities in other parts of the world. (excerpt)