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. 2007 Jan 13;369(9556):132-8.
doi: 10.1016/S0140-6736(07)60074-9.

Syphilis in China: results of a national surveillance programme

Zhi-Qiang Chen  1 , Guo-Cheng Zhang, Xiang-Dong Gong, Charles Lin, Xing Gao, Guo-Jun Liang, Xiao-Li Yue, Xiang-Sheng Chen, Myron S Cohen
Affiliations

Syphilis in China: results of a national surveillance programme

Zhi-Qiang Chen et al. Lancet. .

Abstract

Background: After a massive syphilis epidemic in the first half of the 20th century, China was able to eliminate this infection for 20 years (1960-80). However, substantial changes in Chinese society have been followed by a resurgent epidemic of sexually transmitted diseases. Sporadic reports have provided clues to the magnitude of the spread of syphilis, but a national surveillance effort is needed to provide data for planning and intervention.

Methods: We collected and assessed case report data from China's national sexually transmitted disease surveillance system and sentinel site network.

Findings: In 1993, the reported total rate of cases of syphilis in China was 0.2 cases per 100,000, whereas primary and secondary syphilis alone represented 5.7 cases per 100,000 persons in 2005. The rate of congenital syphilis increased greatly with an average yearly rise of 71.9%, from 0.01 cases per 100,000 livebirths in 1991 to 19.68 cases per 100 000 livebirths in 2005.

Interpretation: The results suggest that a range of unique biological and social forces are driving the spread of syphilis in China. A national campaign for detection and treatment of syphilis, and a credible prevention strategy, are urgently needed.

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Figures

Figure 1
Figure 1
Map of 26 national STD sentinel sites in China
Figure 2
Figure 2
Reporting structure of China's nationwide STD surveillance system
Figure 3
Figure 3
Reported incidence of congenital syphilis and cumulative primary and secondary syphilis in China from 1988 to 2005, nationwide STD surveillance system *Aside from congenital syphilis, classification into different stages of syphilis was introduced in 1996. Thus, before 1996, data points for primary and secondary syphilis show incidence for total syphilis. However, an ad hoc survey of syphilis reports in 38 cities from 1990 to 1994 suggested that reported cases of primary, secondary, early latent, tertiary, and congenital syphilis accounted for 20·2%, 46·5%, 28·1%, 2·1%, and 0·7% of total cases, respectively.
Figure 4
Figure 4
Incidence of total syphilis in 2005 by province, nationwide STD surveillance system Numbers in parentheses show number of provinces in band.
Figure 5
Figure 5
Comparison of incidence of syphilis reported by 26 sentinel sites and nationwide STD surveillance system
See this image and copyright information in PMC

Comment in

  • Syphilis resurgent in China.
    Fisman DN. Fisman DN. Lancet. 2007 Jan 13;369(9556):84-5. doi: 10.1016/S0140-6736(07)60044-0. Lancet. 2007. PMID: 17223453 No abstract available.
  • Congenital syphilis in China.
    Senanayake S. Senanayake S. Lancet. 2007 Apr 7;369(9568):1165; author reply 1165. doi: 10.1016/S0140-6736(07)60555-8. Lancet. 2007. PMID: 17416254 No abstract available.

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