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Syphilis and social upheaval in China.

In their Perspective article Tucker et al. (May 6 issue)1 report that rapid increases in cases of congenital syphilis in China have generated great concern. Although sexually transmitted diseases (STDs) have become major notifiable diseases in China2 a review by an expert panel concluded in February 2008 that the rapid increase in reported cases of syphilis was primarily caused by systematic changes in diagnosis and reporting because a nationwide Web-based real-time reporting system was introduced in 2004.3 National surveillance of pregnant women with syphilis in China suggested that there was no significant change in the incidence between 2005 and 2009. In 2008 the Shanghai Center for Quality Control of STD Treatment conducted a specific investigation of the increase in reports of congenital syphilis; it revealed that most reported cases were misdiagnosed. For example among 42 infants with congenital syphilis who were followed for 12 months all the rapid plasma reagin tests and Treponema pallidum particle agglutination assays became negative between 3 and 10 months after birth. Such misdiagnosis and overreporting of congenital syphilis have also occurred in Detroit.4 These findings remind us that we must understand how data are being collected and reported so that we can interpret them appropriately. (full-text)