Syphilis, virtually eradicated after the founding New China in
1949, has become a viciously-growing epidemic there, driven by
prostitution, internal migration and poor health controls, a new
study warns.
In 1993, the reported rate of syphilis in China was a mere 0.2
cases per 100,000.
A Chinese prostitute is caught in bed
with two men at a brothel in Guangzhou. Syphilis has become a
viciously-growing epidemic there, driven by prostitution, internal
migration and poor health controls, a new study warns.
In 2005, it had surged to 5.7 cases per 100,000, a figure that
may well be a serious under-estimate, according to the paper by
Chinese epidemiologists.
In addition, the number of babies born with syphilis has shot
up. Congenital syphilis occurred among just 0.01 per 100,000 live
births in 1991; in 2005 it was 19.68 -- an annual rise of nearly 72
percent over that time.
"Surveillance data and focussed reports from throughout China
provide compelling evidence of a substantial and worsening syphilis
epidemic in individuals at high risk and in the general
population," the research says.
"The spread of syphilis in China has been insidious and has only
recently attracted the attention it deserves."
The paper, written by experts from China's National Centre for
STD (Sexually Transmitted Diseases) Control, appears in Saturday's
issue of the British health journal The Lancet.
Syphilis is a sexually transmitted disease caused by a
bacterium, Treponema pallidum, that can be treated by antibiotics.
If untreated, it can cause genital ulcers, damage the
cardiovascular and nervous systems and brain, affect fertility and
foetal health.
By the time New China was founded in 1949, China had one of the
biggest syphilis epidemics in history: one person in 20 in some
large cities had the disease, and the rate was two to three percent
among dwellers in the countryside.
In 1952, the Chinese government launched an unprecedented
campaign, instituting mass screening for the T. pallidum germ,
providing free treatment to infected individuals and closing
brothels. By the 1960s, the initiative virtually eradicated
syphilis in China.
The Lancet paper says that this success ironically worsened the
danger for the Chinese population when the country opened up its
economy in the 1990s, unleashing the social earthquake that
continues to this day.
As syphilis had been virtually absent for 20 years, the general
population of young, sexually active individuals had become
"completely susceptible" to infection, it says.
The driver for the epidemic has mainly been sex work, which has
risen with the expansion of China's vast, shifting population of
migrant workers.
There have also been changes in sexual habits, including a move
towards sexual intercourse at an earlier age, with more partners
and before marriage but also with poor use of condoms.
Syphilis prevalence is highest in the big-growth regions of
coastal China, led by Shanghai (55.3 cases per 100,000), Zhejiang
(35.9) and Fujian (26.8).
This was followed by Beijing (24.9 cases per 100,000) and the
Zhujiang river delta, comprising Guangxi, Guangdong and Hainan
provinces, with rates of 14-21 per 100,000 individuals.
Other countries have likewise reported a resurgence of syphilis
in high-risk groups recent years. The United States reported a 2.7
per cent nfection rate in 2004.
The paper, lead-authored by Chen Xiangsheng, admits that the
picture could be even worse, as the data is based on 26 nationwide
"sentinel sites" which receive details of patient admissions from
government STD clinics.
Many people, though, may get treated at family planning centres,
gynaecological clinics and other facilities or by pharmacists or
private practitioners, and these cases go largely unreported.
In addition, the increasing privatisation of health care in
China has left many people without the resources to get screened or
treated for syphilis.
(China Daily January 13, 2007)
