Background Guangdong province in southern China is at the centre of a national syphilis epidemic, with a tenfold increase of reported syphilis cases in the past ten years. However, the epidemic remains poorly described in rural areas of Guangdong, where hygiene stations (community-level clinics) lack the capacity to undertake routine prenatal syphilis screening. The purpose of this research was to determine the prevalence of syphilis and its risk factors among pregnant women, and to assess the acceptability of point-of-care tests in resource-limited areas of Guangdong province.

Methods From June 2010 to April 2012, we invited 55 hygiene stations, 12 general hospitals, and four women and children’s hospitals in resource-limited areas of Guangdong province to participate in the study. Free point-of-care syphilis testing were provided to each of the study sites, and positive samples were confirmed at local referral centres by toluidine red unheated serum test (TRUST)) and Treponema pallidum particle agglutination (TPPA) test. Confirmed cases received free treatment with benzathine penicillin.

Results A total of 27,150 pregnant women were screened for syphilis by point-of-care syphilis tests, 106 (0.39%) syphilis cases were diagnosed, of which 78 cases (73.6%) received treatment for syphilis. Syphilis infection among pregnant women was associated with older age and a previous history of adverse pregnancy.

Conclusions Syphilis infection is a significant problem among pregnant women living in rural areas of southern China. Point-of-care syphilis testing was well accepted in resource-limited settings, and can increase case detection in rural areas with limited testing capacity.