Objective To understand the infection rate of Treponema pallidum and influencing factors in voluntary blood donors in China, and provide scientific evidence for the development of targeted blood donation promotion and blood source recruitment strategies.

Methods Literature retrieval of publications about T. pallidum infection in voluntary blood donors in China from May 2015 to May 2025 was conducted by using databases such as Pubmed, Wanfang, and China National Knowledge Infrastructure. Strengthening the reporting of observational studies in epidemiology statement was used to evaluate the quality of the included literature and meta-analysis on syphilis infection rate in the voluntary blood donors was conducted by using Stata 18.0. Subgroup analysis was performed in terms of area, age, survey time, occupation, education level, gender, marital status and the number of blood donations.

Results A total of 32 papers were included, involving 6518349 blood donors. Among them, 21401 blood donors were infected with T. pallidum, the infection rate was 318.99/100000 (95%CI: 259.21/100000−378.77/100000). Subgroup analysis showed that no significant differences in T. pallidum infection rates among different gender and marital status groups (P<0.05), while significant difference in T. pallidum infection rates was found among the blood donors in different area, age, survey time, occupation, education level, and blood donation time groups (P<0.05). The T. pallidum infection rates in the blood donors in western, eastern, and central China were 521.30/100000, 375.50/100000 and 176.97/100000, respectively; the T. pallidum infection rates in the blood donors in age groups 18−<35, 35−<45 and 45−60 years were 207.72/100000, 419.60/100000 and 471.03/100000, respectively; the T. pallidum infection rate in the blood donors was 432.40/100000 during 2004−2015 and 226.90/100000 during 2016−2022; the T. pallidum infection rate in the blood donors was 107.06/100000 in student group, and 371.25/100000 in other groups; the T. pallidum infection rates in the blood donors with education level of university or above and high school or below were 122.74/100000 and 393.10/100000, respectively; the T. pallidum infection rates in the first-time and repeated blood donors were 541.37/100000 and 57.19/100000, respectively.

Conclusion The T. pallidum infection rate in the voluntary blood donors in China was at moderate level compared with other countries, but it decreased significantly in recent years. Students, highly educated individuals and those who has repeated blood donation are low-risk groups for T. pallidum infection, indicating that they can be defined relatively safe blood donors.