Syphilis, a sexually transmitted infection (STI) that was nearly eliminated from China 50 years ago, is now the most commonly reported communicable disease in Shanghai, China's largest city. No other country has seen such a precipitous increase in reported syphilis cases in the penicillin era. In 2008, an average of more than 1 baby per hour was born with congenital syphilis in China, for a total of 9480 cases; the rate had increased by a factor of 12 during the previous 5 years. A disease with social roots, syphilis has become a major scourge lurking in the shadows of a country that has rapidly ascended to the status of a global economic powerhouse.
Although syphilis infection may be asymptomatic and difficult to diagnose without widespread screening, the public health impact of the disease is all too clear. People with syphilis have an increased risk of acquiring and transmitting human immunodeficiency virus (HIV) infection; more than half of pregnant women with syphilis have a spontaneous abortion or stillbirth; and babies with congenital syphilis may have serious, irreversible sequelae with rates of death in infancy of more than 50%.
The recent expansion of the Chinese syphilis epidemic holds important lessons about social and environmental influences on sexual health, and these lessons have corollaries for other countries and cultures. But in China, the breadth and depth of social change during the past two decades have far exceeded the incremental urbanization and development seen in other low- and middle-income countries. Just as past major social upheavals, including world wars, have been associated with an increased rate of STIs, contemporary social factors have an effect on both the spread and control of syphilis. NEJM
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