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posted Friday, May 14, 2010 - Volume 38 Issue 20
Syphilis epidemic in China reflects free-market growth
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Syphilis epidemic in China reflects free-market growth

by Mike Andrew - SGN Staff Writer

Once nearly eradicated in China, syphilis is now the leading STD in Shanghai, China's largest and richest city.

According to a new study published in the New England Journal of Medicine on May 6, newly diagnosed cases are increasing by 30% every year, with the official government number tripling between 2004 and 2008 to nearly 280,000.

The rate of mother-to-child transmission jumped from 7 to 57 cases per 100,000 live births between 2003 and 2008, the study found.

"In the '50s and '60s in China, syphilis and other STDs were extremely uncommon. The number of new cases has just rapidly accelerated," the study's lead author, Dr. Joseph Tucker said. "Even one baby born with syphilis in China is unacceptable."

Tucker is an infectious disease specialist at the University of North Carolina at Chapel Hill.

Some of the increase can be attributed to better reporting and screening, and one reason why the rate of syphilis among newborns may be growing faster is because they are being tested more often than in the past.

Nevertheless, the study found that prostitutes, along with Gay and Bi men - many of them married, with children - were driving the increases.

The Chinese Communist government succeeded in nearly eliminating syphilis through a mass campaign in the 1960s. Brothels were closed, and prostitutes were given free medical treatment for STDs. A mass propaganda campaign encouraged regular screenings and safer sexual practices.

As free-market reforms transformed China's economy in the 1980s, the disease rebounded at an unprecedented rate, however.

The increase in syphilis infections reflects the growth of a cash-based industrial economy, providing both Chinese businessmen and migrant laborers with disposable income, and opportunities to buy unsafe sex while away from home.

China's integration into the global economy and its government's desire to market the country as a cosmopolitan business and tourist destination has also led to a growing sex industry in business centers like Shanghai and tourist resorts like Dali.

Unlike other STDs, such as gonorrhea or Chlamydia, syphilis destroys the central nervous system and can be fatal if left untreated.

"This damage is irreversible," said Dr. Connie Osborne, a senior HIV adviser at WHO in China. "Prevention of maternal syphilis combined with routine screening of pregnant women and early treatment of neonatal syphilis can prevent most, if not all, cases."

The disease is relatively simple to cure. Usually only a shot of penicillin is required, but many people never experience specific symptoms and consequently the disease often remains undiagnosed.

Unfortunately, China does not require routine syphilis screenings for pregnant women.

Since the 1990s, China's government has made huge strides in openly addressing the spread of HIV, which is easier to transmit and catch if other infections, like syphilis, are also present.

Social stigma remains a huge barrier for people infected with any STD, however, making it important for tests and treatment to be moved out of doctors' offices and into brothels, nightclubs and communities where high-risk groups gather.

Reaching married men who have sex with men in China is particularly tricky because they remain deeply closeted and do not associate with Gay men socially, according to Paul Causey, a consultant with the Asia Pacific Coalition on Male Sexual Health in Bangkok.

Chen Xiangsheng, deputy director of China's National Center for Sexually Transmitted Disease Control, said that his government needs to do a better job of integrating screening for HIV and other STDs, as well as figuring out how and when testing and treatment should be carried out all the way down to the community level.

Chen's observations were published last fall in a World Health Organization (WHO) journal. Chen also co-authored the NEJM study.

"Unlike many Western countries, China does not have an STI public health program - which it should have," he said. "State policy has focused mainly on HIV/AIDS."

WHO estimates some 12 million people worldwide are infected with syphilis every year. The disease affects some 2 million pregnancies, with about one quarter of them resulting in miscarriages or stillbirths.

Twenty-five percent of the babies who survive are born underweight or with serious infections, increasing a newborn's risk of death during the first fragile weeks of life. Syphilis can also cause deafness, neurological problems or bone deformities in newborns.

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