A syphilis epidemic hits China

Every hour, around 1,900 children are born in China. At least one of those helpless squalling babes will have congenital syphilis—and that rate has exploded by a factor of 12 in the last five years. Syphilis is now the No. 1 communicable disease in Shanghai. The nation is in the midst of the fastest-growing epidemic of the disease the world has seen since Alexander Fleming discovered penicillin, which can quickly cure the sexually transmitted infection (STI).

The outbreak reflects the explosive growth in the Asian nation’s economy and the resultant social upheaval, which has expanded the sex trade industry and its clients. “The men are called ‘MMM’—mobile men with money—who travel away from women on business and often return with syphilis,” says Dr. Joseph Tucker, a co-author of a commentary on the crisis published in last week’s New England Journal of Medicine. Another problem: “The social stigma associated with high-risk behaviours is a powerful deterrent to widespread syphilis-screening efforts.” Sex workers often fear public authorities, including official STI clinics, since “the police’s traditional response [to prostitution] has ranged from fines to detention in ‘re-education centres.’ ” Since the bacterial infection—which often has no early symptoms—can be difficult to diagnose without widespread public screening, co-author Rosanna Peeling of the London School of Hygiene & Tropical Medicine is running a project that targets both prenatal and high-risk populations for quick-result syphilis tests.

Tucker is hopeful the new strategies will work. (He points out that China is tackling another communicable disease, HIV, with progressive programs including needle exchanges and methadone treatment.) Yet, in a country that largely eliminated syphilis a half-century ago, the disease infects nearly 60 out of every 100,000 babies in the Middle Kingdom, compared to Canada’s rate of two per 100,000. Because pregnancy complications include stillbirth and spontaneous abortion, Peeling worries that “the reported cases represent only the tip of the iceberg.”