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Open Access Research article

Primary syphilis cases in Guangdong Province 1995-2008: Opportunities for linking syphilis control and regional development

Li-Gang Yang1*, Joseph D Tucker2, Bin Yang1, Song-Ying Shen1, Xi-Feng Sun1, Yong-Feng Chen1 and Xiang-Sheng Chen3

Author Affiliations

1 Guangdong Provincial Center for Skin Disease & STI Control, Guangzhou, PR China

2 Division of Infection Diseases, Massachusetts General Hospital, Boston, USA

3 National STD Control Center, Chinese Academy of Medical Sciences, Peking Union Medical College Institute of Dermatology, Nanjing, PR China

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BMC Public Health 2010, 10:793  doi:10.1186/1471-2458-10-793

Published: 30 December 2010

Abstract

Background

Syphilis cases have risen in many parts of China, with developed regions reporting the greatest share of cases. Since syphilis increases in these areas are likely driven by both increased screening and changes in sexual behaviours, distinguishing between these two factors is important. Examining municipal-level primary syphilis cases with spatial analysis allows a more direct understanding of changing sexual behaviours at a more policy-relevant level.

Methods

In this study we examined all reported primary syphilis cases from Guangdong Province, a southern province in China, since the disease was first incorporated into the mandatory reporting system in 1995. Spatial autocorrelation statistics were used to correlate municipal-level clustering of reported primary syphilis cases and gross domestic product (GDP).

Results

A total of 52,036 primary syphilis cases were reported over the period 1995-2008, and the primary syphilis cases increased from 0.88 per 100,000 population in 1995 to 7.61 per 100,000 in 2008. The Pearl River Delta region has a disproportionate share (44.7%) of syphilis cases compared to other regions. Syphilis cases were spatially clustered (p = 0.01) and Moran's I analysis found that syphilis cases were clustered in municipalities with higher GDP (p = 0.004).

Conclusions

Primary syphilis cases continue to increase in Guangdong Province, especially in the Pearl River Delta region. Considering the economic impact of syphilis and its tendency to spatially cluster, expanded syphilis testing in specific municipalities and further investigating the costs and benefits of syphilis screening are critical next steps.