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Background <p>Syphilis has emerged as a major public health challenge in China and is characterized by increasing incidence rates and shifting epidemiological patterns. Despite national control efforts, latent syphilis dominates case burdens, and older adults have become a high-risk subgroup, highlighting the need for updated prevention strategies.</p> Methods <p>We analyzed data from China’s National Notifiable Disease Surveillance System (2005–2020), including 5,899,261 syphilis cases and 994 deaths, to describe incidence, mortality, and stage-specific trends. Joinpoint regression was used to model annual percentage changes (APCs) in incidence/mortality, and descriptive statistics were used to assess age/regional distributions.</p> Results <p>Latent syphilis accounted for 64.02% of the total cases, with the incidence increasing rapidly from 2005 to 2010 (APC = 29.99%) before slowing (2010–2020: APC = 8.44%). Individuals aged ≥ 60 years presented the highest burden, with an incidence rate of 46.9224 /100,000 (23.90% of cases) and a mortality rate of 0.0133/100,000 (40.24% of deaths), driven by latent syphilis (80.25% of mortality). Regional disparities were evident, with eastern provinces as endemic hotspots and western regions experiencing rapid growth (e.g., Xizang). Primary/secondary syphilis initially increased but then decreased, whereas tertiary/congenital syphilis remained low but persistent.</p> Conclusion <p>Western regions such as Xizang have shown a notable syphilis incidence growth rate, surpassing eastern endemic hotspots and revealing a distinct “reverse gradient”. Dominated by asymptomatic latent infections and marked by the aging population’s vulnerability, China’s syphilis epidemiology demands targeted interventions: universal screening, age-tailored education for older adults, and strengthened western-region surveillance. These measures tackle transmission dynamics, align with global STI elimination goals, and address regional inequities to advance tailored public health strategies.</p>

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Epidemiological characteristics of syphilis in China from 2005 to 2020: predominance of latent Infections, significant burden in the elderly population, and analysis of regional disparities

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2025年12月6日

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  • Yajun Qiao,
  • Juan Guo,
  • Ruiying Cheng,
  • Xingfang Zhang,
  • Xiaohui Li,
  • Huimin Zheng,
  • Lixin Wei,
  • Zhongshu Shan,
  • Hongtao Bi

摘要

Background

Syphilis has emerged as a major public health challenge in China and is characterized by increasing incidence rates and shifting epidemiological patterns. Despite national control efforts, latent syphilis dominates case burdens, and older adults have become a high-risk subgroup, highlighting the need for updated prevention strategies.

Methods

We analyzed data from China’s National Notifiable Disease Surveillance System (2005–2020), including 5,899,261 syphilis cases and 994 deaths, to describe incidence, mortality, and stage-specific trends. Joinpoint regression was used to model annual percentage changes (APCs) in incidence/mortality, and descriptive statistics were used to assess age/regional distributions.

Results

Latent syphilis accounted for 64.02% of the total cases, with the incidence increasing rapidly from 2005 to 2010 (APC = 29.99%) before slowing (2010–2020: APC = 8.44%). Individuals aged ≥ 60 years presented the highest burden, with an incidence rate of 46.9224 /100,000 (23.90% of cases) and a mortality rate of 0.0133/100,000 (40.24% of deaths), driven by latent syphilis (80.25% of mortality). Regional disparities were evident, with eastern provinces as endemic hotspots and western regions experiencing rapid growth (e.g., Xizang). Primary/secondary syphilis initially increased but then decreased, whereas tertiary/congenital syphilis remained low but persistent.

Conclusion

Western regions such as Xizang have shown a notable syphilis incidence growth rate, surpassing eastern endemic hotspots and revealing a distinct “reverse gradient”. Dominated by asymptomatic latent infections and marked by the aging population’s vulnerability, China’s syphilis epidemiology demands targeted interventions: universal screening, age-tailored education for older adults, and strengthened western-region surveillance. These measures tackle transmission dynamics, align with global STI elimination goals, and address regional inequities to advance tailored public health strategies.