Syphilis In China Research Articles

Epidemiological characteristics of syphilis in mainland China, 2004 to 2019.

Syphilis is a globally prevalent sexually transmitted infection. This study aimed to elucidate the epidemiological characteristics of syphilis in China from 2004 to 2019. Incidence data for syphilis across 31 provinces in mainland China were obtained from the Data Center of China Public Health Science for the period from 2004 to 2019. Epidemiological methods and the Chi-squared test were used to analyze the temporal, regional, and disease stage distributions of syphilis. In total, 5,527,399 syphilis cases were reported in China from 2004 to 2019, with an average annual prevalence of 25.7063 per 100,000 population and overall increasing trend. In terms of regional distribution, high-incidence provinces included Shanghai, Zhejiang, Fujian, Guangxi, Guangdong, Xinjiang, Ningxia, and Qinghai. The proportion of latent syphilis increased from 20.41% in 2004 to 82.95% in 2019, with an upward trend each year. Syphilis incidence exhibited an overall increasing trend in China, and latent syphilis was predominant. Syphilis incidences considerably varied among regions, and syphilis was detected from coastal to inland provinces. Thus, syphilis prevention and control programs should be tailored according to the specific epidemiological characteristics of each region.

Development and validation of an individualised nomogram to predict mother-to-child transmission in pregnant women with syphilis in China: a retrospective cohort study

ObjectivesThe elimination of mother-to-child transmission (MTCT) of syphilis has been set as a public health priority. However, an instrument to predict the MTCT of syphilis is not available. We aimed...

Rapid resurgence of syphilis in Japan after the COVID-19 pandemic: A descriptive study.

Some countries have reported a post-pandemic resurgence in syphilis prevalence, but trend data in the World Health Organization Western Pacific Region (WHO-WPRO), including Japan, are severely lacking. Thus, the present study compares the number of syphilis cases before and after the COVID-19 pandemic in some WHO-WPRO countries. In addition, temporal trends in the number of syphilis cases in Japan pre- and post-pandemic are described. Annual numbers of syphilis cases during the study periods from China, New Zealand, Australia and Japan were compared. Annual trends of the numbers of syphilis cases during the same study periods were examined in Japan. In 2020, the number of syphilis-positive cases decreased in all four countries. In 2021, though, China, Australia and Japan all showed an increase in the numbers of syphilis cases. However, the rate of increase in China (+2.8%) and Australia (+4.8%) was low compared to Japan (+36.0%). The number of syphilis cases in New Zealand in 2021 was 12.6% lower than in 2020. In 2022, the number of cases of syphilis in China was 7.4% lower than in 2021. The increase of syphilis-positive cases was approximately 6.3-fold higher in Japan compared to Australia (+66.2% vs. +10.5%) in 2022. In conclusion, post-pandemic resurgence of syphilis occurred in Australia and Japan, but not in China and New Zealand. The reason for the substantial increase in syphilis-positive cases in Japan remains unclear. Post-pandemic, prevention and control of sexually transmitted infections still require attention.

Impact of COVID-19 epidemic on syphilis case reporting in China

Objective: To analyze the impact of COVID-19 epidemic on syphilis case reporting in China, and provide evidence to evaluate the epidemic situation of syphilis and strengthen the prevention and control of syphilis during COVID-19 epidemic. Methods: The data were collected from the National Notifiable Infectious Disease Reporting System of China Information System for Disease Control and Prevention, National STD Management Information System, and the "nCov2019" R package of github website. The changes of reported cases of syphilis before and during COVID-19 epidemic in China were analyzed. Joinpoint regression model was established by using the reported case number of syphilis from 2010 to 2018, the data in 2019 was used for validation, and the number of syphilis cases in 2020 and 2021 was predicted. The impact of COVID-19 epidemic on the number of syphilis cases was evaluated with calculating the percentage error (PE) between actual number and predicted number of syphilis cases reported.The correlation between reported cases of syphilis and COVID-19 was analyzed by Spearman's correlation analysis. The softwares of Joinpoint 4.9.1.0 and SPSS 18.0 were used for statistical analysis. Results: In 2020 and 2021, the reported cases of syphilis in China decreased significantly by 13.32% and 10.41%, respectively, compared with 2019 (before COVID-19 epidemic), and the reported cases of syphilis in 2021 increased by 3.36% compared with 2020. The reported cases of syphilis in 2020 and 2021 decreased by 17.95% and 20.41%, respectively, compared with predicted numbers. From January to March 2020, the reported monthly case number of syphilis was completely negatively correlated with the confirmed case number of COVID-19 (rs=-1.00, P<0.001). In the provinces with different scales of COVID-19 epidemic, there was also a negative correlation between the monthly reported case number of syphilis and confirmed case number of COVID-19 (all P<0.05). Conclusions: In China, the change of reported cases of syphilis was closely associated with COVID-19 epidemic in 2020 and 2021. Due to the influence of COVID-19 epidemic, the number of reported cases of syphilis decreased significantly, but it should not be thought that syphilis incidence will become a decline trend in the future. It is necessary to carefully and scientifically assess the changes in syphilis epidemic.

Analysis of Adverse Pregnancy Outcomes of Pregnant Women with Syphilis and Maternal-Infant Serological Association in Changzhou, China, 2015-2019.

Background Although the prevention of mother-to-child transmission of syphilis program in China has achieved national coverage for 7 years, controversy still exists regarding the treatment of syphilis and the serological significance of syphilis. Objective To explore the occurrence and influencing factors of adverse pregnancy outcomes among pregnant women with syphilis in Changzhou from 2015-2019 and to further analyze the impact of syphilis serologic titers on perinatal outcomes and neonatal serologic outcomes. Methods Syphilis-infected pregnant women reported in Changzhou City from 2015 to 2019 were selected as the study population (data were obtained from the “China Information System for Prevention of Mother-to-child Transmission of AIDS, Syphilis and Hepatitis B.” Demographic characteristics, laboratory tests, and medication were collected to describe adverse pregnancy outcomes and the distribution of non-pale leptospiral antibody titers during pregnancy. Multivariate logistic regression was used to analyze the factors influencing adverse pregnancy outcomes. We also compared differences in syphilis titers among mothers who received different interventions, differences in serologic outcomes of their children, and correlations between them. Results For mothers with syphilis infection, we found no treatment during pregnancy (OR =1.70) and an initial titer greater than 1 : 8 (OR =2.28) to be risk factors. For treated pregnant women, increasing age (OR =1.08), lack of standardized treatment (OR =1.87), and initial titer greater than 1 : 8 (OR =1.69) were risk factors, while previous parity was a protective factor (OR =0.62). For untreated pregnant women, marital status (OR =2.40) and initial titers greater than 1 : 8 (OR =3.57) were risk factors. There were statistically significant differences (P < 0.01) in serologic titer changes, time to antibody regression, and time to exclusion of syphilis infection in children of pregnant women with syphilis infection after receiving different interventions during pregnancy, but different time distributions of interventions had no effect on these three indicators. Conclusion Pregnant women with syphilis should actively cooperate with their doctors in the standardized treatment of pregnancy, and doctors should also pay more attention to pregnant women with syphilis whose initial titers are greater than 1 : 8. High-quality prenatal care is a key component in interrupting mother-to-child transmission of syphilis and preventing various adverse pregnancy outcomes. The adaptation of standardized treatment protocols for pregnant women with syphilis in China is a strong proof of the progress of precision medicine.

Development and comparison of predictive models for sexually transmitted diseases-AIDS, gonorrhea, and syphilis in China, 2011-2021.

BackgroundAccurate incidence prediction of sexually transmitted diseases (STDs) is critical for early prevention and better government strategic planning. In this paper, four different forecasting models were presented to predict the incidence of AIDS, gonorrhea, and syphilis.MethodsThe annual percentage changes in the incidence of AIDS, gonorrhea, and syphilis were estimated by using joinpoint regression. The performance of four methods, namely, the autoregressive integrated moving average (ARIMA) model, Elman neural network (ERNN) model, ARIMA-ERNN hybrid model and long short-term memory (LSTM) model, were assessed and compared. For 1-year prediction, the collected data from 2011 to 2020 were used for modeling to predict the incidence in 2021. For 5-year prediction, the collected data from 2011 to 2016 were used for modeling to predict the incidence from 2017 to 2021. The performance was evaluated based on four indices: mean square error (MSE), mean absolute error (MAE), and mean absolute percentage error (MAPE).ResultsThe morbidities of AIDS and syphilis are on the rise, and the morbidity of gonorrhea has declined in recent years. The optimal ARIMA models were determined: ARIMA(2,1,2)(0,1,1)12, ARIMA(1,1,2)(0,1,2)12, and ARIMA(3,1,2)(1,1,2)12 for AIDS, gonorrhea, and syphilis 1-year prediction, respectively; ARIMA (2,1,2)(0,1,1)12, ARIMA(1,1,2)(0,1,2)12, and ARIMA(2,1,1)(0,1,0)12 for AIDS, gonorrhea and syphilis 5-year prediction, respectively. For 1-year prediction, the MAPEs of ARIMA, ERNN, ARIMA-ERNN, and LSTM for AIDS are 23.26, 20.24, 18.34, and 18.63, respectively; For gonorrhea, the MAPEs are 19.44, 18.03, 17.77, and 5.09, respectively; For syphilis, the MAPEs are 9.80, 9.55, 8.67, and 5.79, respectively. For 5-year prediction, the MAPEs of ARIMA, ERNN, ARIMA-ERNN, and LSTM for AIDS are 12.86, 23.54, 14.74, and 25.43, respectively; For gonorrhea, the MAPEs are 17.07, 17.95, 16.46, and 15.13, respectively; For syphilis, the MAPEs are 21.88, 24.00, 20.18 and 11.20, respectively. In general, the performance ranking of the four models from high to low is LSTM, ARIMA-ERNN, ERNN, and ARIMA.ConclusionThe time series predictive models show their powerful performance in forecasting STDs incidence and can be applied by relevant authorities in the prevention and control of STDs.

Expanding syphilis test uptake using rapid dual self-testing for syphilis and HIV among men who have sex with men in China: A multiarm randomized controlled trial.

Low syphilis testing uptake is a major public health issue among men who have sex with men (MSM) in many low- and middle-income countries. Syphilis self-testing (SST) may complement and extend facility-based testing. We aimed to evaluate the effectiveness and costs of providing SST on increasing syphilis testing uptake among MSM in China. An open-label, parallel 3-arm randomized controlled trial (RCT) was conducted between January 7, 2020 and July 17, 2020. Men who were at least 18 years of age, had condomless anal sex with men in the past year, reported not testing for syphilis in the last 6 months, and had a stable residence with mailing addresses were recruited from 124 cities in 26 Chinese provinces. Using block randomization with blocks of size 12, enrolled participants were randomly assigned (1:1:1) into 3 arms: standard of care arm, standard SST arm, and lottery incentivized SST arm (1 in 10 chance to win US$15 if they had a syphilis test). The primary outcome was the proportion of participants who tested for syphilis during the trial period and confirmed with photo verification and between arm comparisons were estimated with risk differences (RDs). Analyses were performed on a modified intention-to-treat basis: Participants were included in the complete case analysis if they had initiated at least 1 follow-up survey. The Syphilis/HIV Duo rapid test kit was used. A total of 451 men were enrolled. In total, 136 (90·7%, 136/150) in the standard of care arm, 142 (94·0%, 142/151) in the standard of SST arm, and 137 (91·3%, 137/150) in the lottery incentivized SST arm were included in the final analysis. The proportion of men who had at least 1 syphilis test during the trial period was 63.4% (95% confidence interval [CI]: 55.5% to 71.3%, p = 0.001) in the standard SST arm, 65.7% (95% CI: 57.7% to 73.6%, p = 0.0002) in the lottery incentivized SST arm, and 14.7% (95% CI: 8.8% to 20.7%, p < 0.001) in the standard of care arm. The estimated RD between the standard SST and standard of care arm was 48.7% (95% CI: 37.8% to 58.4%, p < 0.001). The majority (78.5%, 95% CI: 72.7% to 84.4%, p < 0.001) of syphilis self-testers reported never testing for syphilis. The cost per person tested was US$26.55 for standard SST, US$28.09 for the lottery incentivized SST, and US$66.19 for the standard of care. No study-related adverse events were reported during the study duration. Limitation was that the impact of the Coronavirus Disease 2019 (COVID-19) restrictions may have accentuated demand for decentralized testing. Compared to standard of care, providing SST significantly increased the proportion of MSM testing for syphilis in China and was cheaper (per person tested). Chinese Clinical Trial Registry: ChiCTR1900022409.

Eliminating Mother-to-Child Transmission of Syphilis: Chinese Practice before and during COVID-19 Pandemics

Mother-to-child transmission (MTCT) of syphilis remains a leading cause of stillbirth and death among neonates in many developing countries. In 2007, World Health Orgernization launched the global elimination of MTCT (EMTCT) of syphilis. Given the high burden of congenital syphilis, China subsequently released the specific national EMTCT policies and programs to reduce MTCT of syphilis. The congenital syphilis incidence rate per 100,000 live births in China has markedly decreased from 69.9 in 2013 to 11.9 in 2019. However, due to the global pandemic of COVID-19, the current measures for eliminating MTCT of syphilis are greatly challenged. In this article, we summarize the strategies and measures for the EMTCT of syphilis in China in the past 20 years, the remarkable achievements by the policy support under the leadership of the government. In the context of COVID-19 pandemics, strengthening emergency response to the regional outbreaks of COVID-19, adopting safe, rapid, early and high-quality clinical care for 100% of pregnant women to receive prenatal syphilis testing services, ensuring the availability of Benzathine penicillin for the treatment, and strengthening the closed-loop management of pregnant women and newborns infected with syphilis are the key measures to determine the effectiveness of MTCT for syphilis. Lessons from China may be valuable for other countries that are planning to eliminate MTCT of syphilis.

Expanding Syphilis Test Uptake Using Rapid Dual Self-Testing for Syphilis and HIV among Men Who Have Sex with Men: A Multi-Arm Randomized Controlled Trial in China

Background: Low syphilis testing uptake is a major public health issue among men who have sex with men (MSM) in many low- and middle- income countries. Syphilis self-testing (SST) may complement and extend facility-based testing. Objective: To evaluate the effectiveness and costs of providing SST on increasing syphilis testing uptake among MSM in China. Design: Three-arm randomized; controlled trial with concealed allocation. (Chinese Clinical Trial Registry: ChiCTR1900022409) Setting: Online. Participants: 451 MSM were recruited from 124 cities in 26 Chinese provinces. Intervention: Standard SST arm, lottery incentivized SST arm (1 in 10 chance to win $15 if they tested for syphilis), and standard-of-care arm. Both SST arms were offered free syphilis/HIV self-test kits at monthly intervals via mail. Measurements: The proportion of participants who tested for syphilis during the 6-month trial period and confirmed with photo-verification. Results: The proportion of men who had at least one syphilis test during the trial period was 63.4% (95% CI: 54.9 to 71.3) in the standard SST arm, 65.7% (95% CI: 57.1 to 73.6) in the lottery-incentivized SST arm, and 14.7% (95% CI: 9.2 to 21.8) in the standard-of-care arm. The estimated difference in proportions between the standard SST and standard-of-care arm was 48.7% (95% CI: 37.7 to 58.4). The majority (78.5%, 95% CI: 72.0 to 84.1) of syphilis self-testers reported never testing for syphilis. The cost per person tested was $26.55 for standard SST, $28.09 for the lottery incentivized SST, and $66.19 for the standard-of-care. Limitation: The impact of COVID restrictions may have accentuated demand for decentralized testing. Conclusion: Compared to standard-of-care, providing SST significantly increased the proportion of MSM testing for syphilis in China, particularly among men who had never tested for syphilis, and was cheaper (per person tested). Primary Funding Source: National Natural Science Foundation of China (81772240).

Incidence and associated predictors of adverse pregnancy outcomes of maternal syphilis in China, 2016-19: a Cox regression analysis.

This study aimed to investigate the incidence and associated predictors of adverse pregnancy outcomes (APOs) among pregnant women infected with syphilis. Cox regression analysis. China. Pregnant women who were tested for and diagnosed with syphilis during the index pregnancy and delivered at a gestational age ≥28weeks between 2016 and 2019. Data were extracted from China's Information System of Prevention of Mother-to-Child Transmission of Syphilis Management. Descriptive analysis provided profiles and pregnancy outcomes of maternal syphilis, as well as the incidence of APOs. Log-rank tests and Cox proportional hazard models were used to investigate factors influencing APOs in infected mothers with singleton births. The incidence of APOs and the hazard ratios of associated predictors using Cox proportional hazard model. Syphilis treatment data were available from 83.86% of diagnosed women. Including deliveries from the total study population, 13.33% experienced APOs. Cox regression indicated that APOs were more likely in women tested and diagnosed in the late trimester, at delivery or postpartum. Women who accepted non-standardised treatment and who received standardised treatment had less risk of APOs. China has made huge progress over the last decades in the prevention of mother-to-child transmission of syphilis, but the incidence of APOs among pregnant women infected with syphilis remains high. It is essential to further strengthen access to early detection and standardised treatment of infected women to reduce the risk of APOs. Access to early detection and standardised treatment reduces the risk of APOs due to maternal syphilis.

New screening approach to detecting congenital syphilis in China: a retrospective cohort study

BackgroundDiagnosis of congenital syphilis (CS) is not straightforward and can be challenging. This study aimed to evaluate the validity of an algorithm using timing of maternal antisyphilis treatment and titres...

The Past 70 Years in Control of Syphilis in China: Elimination and Responses to Resurgence

The Past 70 Years in Control of Syphilis in China: Elimination and Responses to Resurgence

Prevalence and protective factors of HIV and syphilis infection among men who have sex with men in Northwest China.

Men who have sex with men (MSM) continue to be disproportionately impacted by human immunodeficiency virus (HIV) and syphilis in China. Little is known about HIV and syphilis infections among MSM in Xi'an, a developing city in Northwest China.A cross-sectional study with recruitment via snowball sampling was conducted to collect HIV and syphilis infection status and risk factors among MSM in Xi'an between April 2013 to December 2016.Among the 5000 participants, the mean age was 29.0 years (SD 7.7) and the prevalence of HIV, syphilis, and coinfection was 6.5%, 2.2%, and 0.4%, respectively. There was no significant change in HIV prevalence from 2013 to 2016, while the prevalence of syphilis and coinfection showed a downward trend. Multiple logistic regression analyses found that being over 25 years old (OR = 1.647), junior high school/middle school education and below (OR = 3.085), with a sexual role of passive or versatile (OR = 3.300; OR = 2.337), rush poppers use during the last 6 months (OR = 1.660) and syphilis infection (OR = 2.235) were more likely to acquire HIV infection, whereas used condoms in the last episode of anal sex (OR = 0.572) and tested HIV antibody previously (OR = 0.252) were protective factors for HIV infection.HIV prevalence among MSM in Xi'an was stable, whereas the prevalence of syphilis and coinfection showed a downward trend. Interventions to promote HIV and sexually transmitted disease testing and condom use should be strengthened, especially for MSM with low education.

Risk Factors for Congenital Syphilis Transmitted from Mother to Infant - Suzhou, China, 2011-2014.

Mother-to-child transmission of syphilis remains a major global public health issue, and elimination of congenital syphilis is one of the millennium development goals of the World Health Organization (1). In 2012, an estimated 930,000 maternal syphilis infections caused 350,000 adverse pregnancy outcomes, including 143,000 early fetal deaths and stillbirths, 62,000 neonatal deaths, 44,000 preterm or low-weight births, and 102,000 infected infants worldwide (2). In China, the number of congenital syphilis cases reported annually increased from 468 in 2000 to 10,032 in 2013; the corresponding national congenital syphilis incidence rate increased nearly 26-fold, from 2.6 cases per 100,000 live births in 2000 to 69.9 in 2013 (3,4). To examine risk factors for mother-to-child transmission of syphilis, a cohort of pregnant women with a new syphilis diagnosis and their live-born infants was recruited during July 2011-July 2014 in Suzhou, in eastern China. Multivariable logistic regression results demonstrated that gestational age >36 weeks at the time of maternal syphilis diagnosis, higher maternal titers of rapid plasma reagin (RPR) and higher Treponema pallidum particle agglutination assay (TPPA) titers are risk factors for congenital syphilis. Among women with syphilis diagnosed at >36 weeks' gestational age, three quarters were migrant women. Recommendations for strengthening community and provider education about mother-to-child transmission of syphilis, early diagnosis and timely treatment of syphilis in pregnancy, and improving and providing access to prenatal care and screening migrant pregnant women with temporary residence status might reduce the incidence of congenital syphilis in China.

Time Series Modelling of Syphilis Incidence in China from 2005 to 2012.

BackgroundThe infection rate of syphilis in China has increased dramatically in recent decades, becoming a serious public health concern. Early prediction of syphilis is therefore of great importance for heath planning and management.MethodsIn this paper, we analyzed surveillance time series data for primary, secondary, tertiary, congenital and latent syphilis in mainland China from 2005 to 2012. Seasonality and long-term trend were explored with decomposition methods. Autoregressive integrated moving average (ARIMA) was used to fit a univariate time series model of syphilis incidence. A separate multi-variable time series for each syphilis type was also tested using an autoregressive integrated moving average model with exogenous variables (ARIMAX).ResultsThe syphilis incidence rates have increased three-fold from 2005 to 2012. All syphilis time series showed strong seasonality and increasing long-term trend. Both ARIMA and ARIMAX models fitted and estimated syphilis incidence well. All univariate time series showed highest goodness-of-fit results with the ARIMA(0,0,1)×(0,1,1) model.ConclusionTime series analysis was an effective tool for modelling the historical and future incidence of syphilis in China. The ARIMAX model showed superior performance than the ARIMA model for the modelling of syphilis incidence. Time series correlations existed between the models for primary, secondary, tertiary, congenital and latent syphilis.

Epidemic Profile of Maternal Syphilis in China in 2013.

Objective. The aim of this study was to investigate the epidemiological characteristics and adverse pregnancy outcomes of pregnant women with syphilis infection in China. Methods. Data were from China's Information System of Prevention of Mother-to-Child Transmission of Syphilis Management. Women who were registered in the system and delivered in 2013 were included in the analysis. Results. A total of 15884 pregnant women with syphilis infection delivered in China in 2013. 79.1% of infected women attended antenatal care at or before 37 gestational weeks; however, 55.4% received no treatment or initiated the treatment after 37 gestational weeks. 14.0% of women suffered serious adverse pregnancy outcomes including stillbirth/neonatal death, preterm delivery/low birth weight, or congenital syphilis in newborns. High maternal titer (≥1 : 64) and late treatment (>37 gestational weeks)/nontreatment were significantly associated with increased risk of congenital syphilis and the adjusted ORs were 1.88 (95% CI 1.27 to 2.80) and 3.70 (95% CI 2.36 to 5.80), respectively. Conclusion. Syphilis affects a great number of pregnant women in China. Large proportions of women are not detected and treated at an early pregnancy stage. Burden of adverse pregnancy outcomes is high among infected women. Comprehensive interventions still need to be strengthened to improve uptake of screening and treatment for maternal syphilis.

P13.05 Prevention of mother-to-child transmission of syphilis and hiv in china: what drives political prioritisation and what can this tell us about promoting dual control?

Introduction Despite a large and growing burden of mother-to-child transmission (MTCT) of syphilis in China over the past 20 years, the issue received far less attention and fewer resources than prevention of MTCT (PMTCT) of HIV, which has a substantially lower burden. China’s Ministry of Health issued the first national plan for syphilis control in 2010, aiming to integrate PMTCT of syphilis and HIV. Our study aimed to identify: 1) why PMTCT of syphilis had a lower political/resource priority than PMTCT of HIV before 2010; and 2) what actions would improve the prospects of successful implementation of dual PMTCT. Methods We undertook a comparative policy analysis, based on informant interviews, documentation review, and nonparticipant observation of relevant meetings/trainings, to investigate priority-setting prior to 2010. We used a nine-factor framework developed by Shiffman et al . which assesses political prioritisation across three categories: transnational influence; domestic advocacy; and national political environment. Results We identified several factors contributing to the lower priority accorded to PMTCT of syphilis: 1) relative neglect at a global level; 2) dearth of international financial and technical support; 3) poorly unified national policy community with weak accountability mechanisms; 4) insufficient understanding of the epidemic and policy options; and 5) a prevailing negative framing of syphilis that resulted in significant stigmatisation. Conclusion The goal of dual PMTCT of syphilis and HIV will only be achieved when equal priority is accorded to both infections. This will require stronger cohesion and leadership from the syphilis policy community. The community will also need to reframe the issue so as to overcome stigmatisation against those affected by the illness, organise focusing events to attract political attention, and work more closely with the HIV policy community in order to enhance the recognition of the need to control syphilis on both the national and sub-national agendas. Disclosure of interest statement This study was funded by the Department of Reproductive Health and Research, World Health Organization during the period from September 2011 to August 2012. The views expressed are not necessarily those of UNAIDS.

S10.3 Sti control in china: what accounts for political priorities?

Introduction Despite a large and growing burden of mother-to-child transmission (MTCT) of syphilis in China over the past 20 years, the issue received far less attention and fewer resources than prevention of MTCT (PMTCT) of HIV, which has a substantially lower burden. China’s Ministry of Health issued the first national plan for syphilis control in 2010, aiming to integrate PMTCT of syphilis and HIV. Our study aimed to identify: 1) why PMTCT of syphilis had a lower political/resource priority than PMTCT of HIV before 2010; and 2) what actions would improve the prospects of successful implementation of dual PMTCT. Methods A comparative policy analysis was undertaken, based on informant interviews, documentation review, and nonparticipant observation of relevant meetings/trainings, to investigate priority-setting prior to 2010. Policy data were analysed by using a nine-factor framework which assesses political prioritization across three categories: transnational influence; domestic advocacy; and national political environment. Results Several factors contributing to the lower priority accorded to PMTCT of syphilis were identified: 1) relative neglect at a global level; 2) dearth of international financial and technical support; 3) poorly unified national policy community with weak accountability mechanisms; 4) insufficient understanding of the epidemic and policy options; and 5) a prevailing negative framing of syphilis that resulted in significant stigmatization. Conclusion The goal of dual PMTCT of syphilis and HIV will only be achieved when equal priority is accorded to both infections. This will require stronger cohesion and leadership from the syphilis policy community. The community will also need to reframe the issue so as to overcome stigmatization against those affected by the illness, organize focusing events to attract political attention, and work more closely with the HIV policy community in order to enhance the recognition of the need to control syphilis on both the national and sub-national agendas.

Laboratory evaluation of three dual rapid diagnostic tests for HIV and syphilis in China and Nigeria

ObjectiveTo determine the laboratory-based performance and operational characteristics of three dual rapid diagnostic tests (RDTs) for testing HIV and syphilis. MethodsThree dual RDTs (SD Bioline, Chembio, and MedMira) were evaluated using 1514 serum specimens archived at laboratories or collected from clinics in China and Nigeria to determine sensitivity and specificity, with 95% confidence intervals. Concordance of testing results read by two technicians, stability of testing results read at two time points, and test operation characteristics were also assessed. ResultsAll three of the evaluated RDTs gave excellent performance with a combined sensitivity ranging from 99.0%–99.6% for HIV and 98.3%–99.0% for syphilis, and a combined specificity ranging from 97.9%–99.0% for HIV and 97.2%–99.6% for syphilis. Concordance of testing results between two technicians and stability of testing results read within and one hour past the recommended reading period showed excellent agreement, with Kappa greater than or equal to 0.98. ConclusionsAll the tests were found to be very or fairly easy to use and easy to interpret the results. Further evaluations of these dual RDTs with whole blood in field settings, and more studies on the implication of introduction of these tests in HIV and syphilis control programs are needed.

Characterization of spatial distribution of syphilis in China, 2011

Objective To characterize the spatial distribution pattern of syphilis at the county level in China,and to provide a new method for syphilis surveillance and control.Methods A national geographic information system (GIS) database was developed based on reported cases of syphilis from all counties in China,2011.Exploratory spatial data analysis (ESDA) methods were used to study the frequency distribution of incidence,global and local spatial autocorrelation,of syphilis.Results The median incidence rate of syphilis was 21.17/100 000 (range:0.00-515.34/100 000; 25th percentile 9.28/100 000,75th percentile 43.00/100 000) in 2 925 counties in the mainland of China in 2011,with a highly positively skewed distribution (skewness =3.11).The global spatial autocorrelation analysis showed a positive spatial autocorrelation of syphilis incidence at the county level in China (global Moran's index =0.576 2,P ＜ 0.001),with the type of correlation being high-high cluster (General G index =0.033 1,P ＜ 0.001).The local spatial autocorrelation analysis delineated hot spots of syphilis (including primary and secondary syphilis,latent syphilis) at the county level.Totally,117 counties,which were mainly distributed in the Yangtze River delta region,northwest,northeastern and south China,were identified as hot spots for syphilis,with the incidence rate of primary or secondary syphilis being higher than 50/100 000.Conclusions The GIS and exploratory spatial data analysis,with the advantages of visualization and accurate localization,may serve as an important novel tool for syphilis surveillance and control. Key words: Syphilis; Geographic information systems; Spatial analysis