Retinal injuries from a handheld laser pointer.

The Authors Reply: Wu and Zhou suggest that some portion of the increase in reported syphilis cases in China may be an artifact of a one-time change in the reporting system in 2004 — an important concern. However, a systematic review of Chinese and English peer-reviewed publications about syphilis trends among both high-risk groups and pregnant women in China suggests that syphilis was spreading before 2004.1 After 2004, we would expect that Web-based reporting would provide a realistic account, consistent with Web-based reporting in other contexts.2 Studies have shown a wide variation in syphilis risk among the approximately 20 million children born in China each year,3,4 making inferences from the sentinel surveillance data to the national situation challenging. The spread of syphilis among men who have sex with men and among nulliparous women who have sex for money could still ultimately affect the occurrence of congenital syphilis. As Wu and Zhou note, accurate diagnosis of congenital syphilis is difficult, but this challenge should not obscure the importance of preventing syphilis and its adverse outcomes in pregnant women. Hesketh and colleagues bring up an excellent point about reexpanding syphilis screening in China — a strategy that is consistent with the strategy proposed by our research group.3 At the same time, concerns about the feasibility of reinstitutionalizing mandatory premarital syphilis testing at the national level in China are not trivial and demand further investigation. The consensus that China has an expanding syphilis epidemic has already served as a call for action that has been enthusiastically answered by public health leadership at multiple levels in China. The Chinese Ministry of Health has already issued a 10-year plan for national syphilis control and prevention. A pilot program of antenatal syphilis screening in Shenzhen, Guangdong Province, screened more than half a million women and showed the feasibility and cost-effectiveness of such programs,5 and now many antenatal clinics routinely provide free syphilis testing there.