By now you may have heard that the New England Journal of Medicine published a perspective piece about the precipitous rise of congenital syphilis in China. The media friendly part of the report [read: easy to digest for the average USA Todayreader] is the number of mainland China babies born with congenital syphilis, in 2008. The actual figure is 9480 babies, which roughly translates into one baby every hour for an entire year.
The other media-friendly part of the report is this bit about syphilis infections being driven by prostitutes, gay men, and social stigma:
“[F]emale sex workers and men who have sex with men disproportionately bear the burden of the Chinese syphilis epidemic, in part because unsafe sexual practices in these populations are driving the rate of infection and in part because the stigma attached to their sexual behaviors discourages them from obtaining needed care. In China, at least one third of men who have sex with men are married, and the transmission of syphilis to their wives and then children is an important consideration,”
Fair enough, but that’s really shortchanging the most interesting information.
The figures presented in the report are uniquely interesting not because of who’s having sex with whom, but because of what changed from 2004 till now.
The first thing to understand is that syphilis is completely curable. And, congenital syphilis, which affects newborn babies, is completely preventable, even after a woman with syphilis is already pregnant. Detection, too, is straight forward, and detection kits themselves are portable, meaning syphilis testing doesn’t require highly trained medical personnel or hospital rooms.
Syphilis, in short, is really a wimpy disease when stacked up against other STDs, like HIV, Herpes, and genital warts. By the same logic, syphilis is a big problem only in places where public health infrastructure has big problems. In place where the public health structure is even moderately effective, syphilis is controlled, and conversely, it thrives where public health measures are weak, like in the mining towns of South Africa or the rural regions of the Southern United States.
The second thing to understand is that China’s syphilis flare up is really weird. Only five years ago, in 2004, China’s syphilis rate was commendable and on par with that of America and other Western countries. There were probably just as many men having sex with prostitutes and other men then as there are now. So, again, who is having sex with whom is not the big issue.
The difference between 2004 and now is that China started presenting it’s public face to the world. If 1978 marked the era of China’s opening, then 2004’s awarding of the Olympics to Beijing marked the era of China’s entrance into world society. The interesting story that the figures tell then, is how China’s entrance into world society negatively impacted the country’s public health.
Prostitutes and gay men have been persecuted against for a long time, in China, not just since 2004. The difference after 2004 is that police and other regulators in China’s Olympic and Expo cities were put under a lot of pressure to ‘clean up the streets’ for international cameras. [pullthis]And they did this by pushing prostitution and gay men further underground, not to mention forcing migrants back to the countrysides and cleaning up the streets of homeless men and women. That’s what we’re seeing reflected in the New England Journal of Medicine report.[/pullthis] And this crackdown on prostitution is at least representative of China’s historic treatment of prostitution since 1978, though I have no similar information for the treatment of gay men. Crackdowns happen in waves every few years, and in the intermittent periods its allowed to exist relatively unchecked.
In this case, the crackdowns probably led to a rise in syphilis, and I’m sure a whole host of other pathogen baddies we haven’t had the time to check up on yet.