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Risk factors for syphilis infection among pregnant women: results of a case-control study in Shenzhen, China
  1. Hua Zhou1,
  2. Xiang-Sheng Chen2,
  3. Fu-Chang Hong1,
  4. Peng Pan1,
  5. Fan Yang1,
  6. Yu-Mao Cai1,
  7. Yue-Ping Yin2,
  8. Rosanna W Peeling3,
  9. David Mabey4
  1. 1Institute of Dermatology, Shenzhen Chronic Disease Hospital, Shenzhen, China
  2. 2National Center for STD Control, Chinese Academy of Medical Sciences and Peking Union Medical College Institute of Dermatology, Nanjing, China
  3. 3World Health Organization, Geneva, Switzerland
  4. 4London School of Hygiene and Tropical Medicine, London, UK
  1. Correspondence to:
 Dr Xiang-Sheng Chen
 National Center for STD Control, 12 Jiangwangmiao Street, Nanjing 210042, China; chenxs{at}


Background: China has been experiencing a rapidly growing syphilis epidemic since the early 1990s, with the reported incidence of congenital syphilis increasing from 0.01 cases per 100 000 live births in 1991 to 19.7 cases per 100 000 live births in 2005. Detailed studies of risk factors for syphilis in pregnant women are needed to inform new preventive interventions.

Objective: To investigate factors associated with recent syphilis infection among pregnant women and recommend strategies for improved preventive interventions in the community.

Methods: A case–control study was conducted among women attending antenatal clinics in Shenzhen City, South China. Cases were antenatal clinic women testing positive for early syphilis, based on laboratory results, with those testing negative being controls. All participants completed the same anonymous questionnaire covering demographics, lifestyle, sexual behaviour, and sexual partnerships.

Results: 129 cases and 345 controls were recruited. Syphilis was significantly associated with unmarried status, less education, multiple sex partners, travel of sex partner in the past 12 months, a history of induced abortion, and previous sexually transmitted infections. Overall, there were no differences between syphilis-positive and negative women in household registration status (hukou), living district and duration in Shenzhen, monthly income, and age at first sex.

Conclusions: Many demographic and behavioural risk factors are associated with syphilis among pregnant women. In the government congenital syphilis control programme, comprehensive preventive interventions should be provided in all clinical settings in addition to the current procedures for syphilis screening among antenatal women.

  • RPR, Rapid plasma reagin
  • STI, sexually transmitted infection
  • TPPA, Treponema pallidum particle agglutination assay
  • syphilis
  • risk factor
  • pregnant women
  • china

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  • Contributors

    XSC was principal investigator who was responsible for the study design, data analysis, and manuscript preparation. HZ and FCH were local principal investigators who were responsible for the local coordination of the study and inputs to manuscript preparation. PP, FY and YMC were responsible for field implementation and data management. YPY, RWP and DM were responsible for inputs and comments to the study design and manuscript preparation.

  • Funding: The study was supported by financial assistance from UNICEF/UNDP/World Bank/WHO Special Programme for Research and Training in Tropical Diseases (TDR) (contract ID: OD/TS-05-00524).

  • Conflict of interest: None.

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