Sixty years after near‑elimination, syphilis surges in China — 640,000 new cases reported in 2025

China’s rising syphilis burden has returned to the national spotlight. China CDC (中国疾控中心) reported that new syphilis cases exceeded 640,000 in 2025, making it the second‑most reported Class B infectious disease after viral hepatitis and some 100,000 cases higher than in 2023. For international context, the World Health Organization (世界卫生组织) estimates roughly 8 million new adult syphilis infections globally in 2022; the U.S. Centers for Disease Control and Prevention (CDC) and other national bodies have also recorded decade‑high increases, underscoring a global reversal in a disease many assumed controllable.

Background: from near‑elimination to resurgence

The scale of the comeback is striking given China’s history. Mass public‑health campaigns in the 1950s — closure of brothels, widespread antibiotic access and grassroots health workers — produced what Beijing medical leaders called a near‑elimination of syphilis by the mid‑1960s. Surveillance resumed in the late 1970s and expanded in the 1980s; reported national cases rose from about 80,000 in 1999 to more than 535,000 by 2019, with an average annual growth near 12% between 2004 and 2019. It has been reported that the cancellation of mandatory premarital screening in 2003 contributed to a steep rise in congenital syphilis, with perinatal impact stark: high rates of miscarriage, stillbirth and severe neonatal morbidity.

Why is eradication elusive?

Syphilis is, medically speaking, an easy target: Treponema pallidum remains highly sensitive to penicillin. So why is it resurging? The answer lies in epidemiology and social dynamics. The pathogen’s long latent phase and nonspecific early symptoms make detection hard; there is no vaccine; and key populations — men who have sex with men and sex workers — carry disproportionately high burdens and face stigma that deters testing. It has been reported that China’s rapid economic and social liberalization, combined with gaps in routine screening and public‑health focus on other priorities, has created conditions for transmission to re‑establish and expand. The New England Journal of Medicine has linked marketization and social change to growing commercial sex networks; similar patterns have been documented elsewhere.

Implications and what’s next

Rising syphilis poses clinical and public‑health risks: coinfection increases HIV transmission risk, and congenital syphilis causes severe, often irreversible outcomes. Public‑health experts call for targeted screening, restoration or strengthening of prenatal testing, better access for marginalized groups, and integrated STI services. Will China reverse the trend? It can, but that will require sustained surveillance, destigmatization of vulnerable groups, and renewed investment in routine sexual health services at a time when global attention is pulled in many directions.