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)