Background Decreasing the congenital syphilis burden across China is a national public health priority mandated by a newly issued National Syphilis Control Plan. But prenatal clinics in some less developed regions of China may have less capacity to implement a routine prenatal syphilis screening. This study examined the local capacity and coverage of syphilis prenatal screening in less developed regions of Guangdong Province, South China.

Methods 11 of the 14 less developed municipalities in Guangdong Province agreed to participate in this study and have a data collection survey under the auspices of the provincial health bureau. Health systems data about availability of syphilis testing, types of syphilis testing, and syphilis test screening among pregnant women were collected from all public medical settings in the study municipalities.

Results Among the 109 clinics where a newborn delivery services were provided, only 40 clinics had syphilis testing. Prenatal clinics that were not hygiene stations, at the municipal or county level, or had greater number of deliveries per year were more likely to have syphilis testing capacity. Overall syphilis screening rates in the 109 medical settings were slightly >50% with higher screening rates at women and children's hospitals, general hospitals, medical setting at higher administrative levels or with greater number of deliveries. Only one women and children hospital had the capacity to conduct both non-treponemal and treponemal tests which are necessary to have for diagnosis of syphilis according to national guidelines.

Discussion Syphilis screening is available at a limited number of township-level and other smaller prenatal clinics in Guangdong Province. With limited laboratory capacity at clinics at lower levels of the healthcare system and increasing prevalence of syphilis in the province, development and implementation of innovative testing strategies, including a rapid syphilis testing that can be easily performed in any healthcare setting is an urgent priority. These findings have important implications not only for successfully achieving the national plan targets of syphilis control but also for syphilis surveillance and monitoring.