Perspective

Syphilis cases reach all-time high in Europe, up 70% in 7 years

Syphilis rates in Europe have steadily increased over the past decade, reaching an all-time recorded high in 2017 with more than 33,000 cases, according to data reported by the European CDC.

The spike has been seen primarily among men who have sex with men (MSM) living in urban areas.

“There is a clear relationship between sexual risk behavior and the risk of syphilis and other sexually transmitted diseases,” Andrew Amato-Gauci, MD, MSc, FFPH, FRCP, head of the European CDC program on HIV, STI and viral hepatitis, said in a news release. “The increases in syphilis infections that we see across Europe, as well as other countries around the world, are a result of several factors such as people having sex without condoms and multiple sexual partners combined with a reduced fear of acquiring HIV.”

Between 2007 and 2017, more than 260,000 confirmed syphilis cases were reported among 30 European Union (EU) and European Economic Area (EEA) countries, data showed. The 33,000 cases reported in 2017 marked a significant increase from 20,000 cases in 2007 and a low of 19,000 cases in 2010.

According to the European CDC, the trend was revealed using notification data from 23 countries with comprehensive surveillance systems that reported data consistently between 2000 and 2017. The notification rate was 70% higher in 2017 than in 2010, marking the first time since the early 2000s that EU/EEA countries reported more syphilis cases than HIV cases, the agency said.

Over the 7-year interval, rates more than doubled in five countries — Iceland (876%), Ireland (224%), the United Kingdom (153%), Germany (144%) and Malta (123%). MSM accounted for 62% of the 152,233 syphilis cases reported between 2007 and 2017 in which the sexual orientation of the patient was known, whereas heterosexual men comprised 23% of cases and women 15%.

In its report, the European CDC recommended several response or control measures for syphilis outbreaks, including screening of at-risk groups, partner notification, case management with appropriate treatment following diagnosis and educational activities directed at the general population, those at-risk of infection and health care providers.

“To reverse this trend, we need to encourage people to use condoms consistently with new and casual partners,” Amato-Gauci said in the release. “Regular tests for syphilis and other sexually transmitted infections should also be part of the parcel, especially if there has been a risk of infection.”

The European CDC also found that congenital syphilis rates and rates of syphilis among women in Eastern Europe have been decreasing since 2005. However, it expressed concern over the likely underreporting of congenital syphilis in several member states and increasing syphilis rates among women in some western EU/EEA countries. – by Joe Gramigna

Disclosure: Amato-Gauci is employed by the European CDC.

Syphilis rates in Europe have steadily increased over the past decade, reaching an all-time recorded high in 2017 with more than 33,000 cases, according to data reported by the European CDC.

The spike has been seen primarily among men who have sex with men (MSM) living in urban areas.

“There is a clear relationship between sexual risk behavior and the risk of syphilis and other sexually transmitted diseases,” Andrew Amato-Gauci, MD, MSc, FFPH, FRCP, head of the European CDC program on HIV, STI and viral hepatitis, said in a news release. “The increases in syphilis infections that we see across Europe, as well as other countries around the world, are a result of several factors such as people having sex without condoms and multiple sexual partners combined with a reduced fear of acquiring HIV.”

Between 2007 and 2017, more than 260,000 confirmed syphilis cases were reported among 30 European Union (EU) and European Economic Area (EEA) countries, data showed. The 33,000 cases reported in 2017 marked a significant increase from 20,000 cases in 2007 and a low of 19,000 cases in 2010.

According to the European CDC, the trend was revealed using notification data from 23 countries with comprehensive surveillance systems that reported data consistently between 2000 and 2017. The notification rate was 70% higher in 2017 than in 2010, marking the first time since the early 2000s that EU/EEA countries reported more syphilis cases than HIV cases, the agency said.

Over the 7-year interval, rates more than doubled in five countries — Iceland (876%), Ireland (224%), the United Kingdom (153%), Germany (144%) and Malta (123%). MSM accounted for 62% of the 152,233 syphilis cases reported between 2007 and 2017 in which the sexual orientation of the patient was known, whereas heterosexual men comprised 23% of cases and women 15%.

In its report, the European CDC recommended several response or control measures for syphilis outbreaks, including screening of at-risk groups, partner notification, case management with appropriate treatment following diagnosis and educational activities directed at the general population, those at-risk of infection and health care providers.

“To reverse this trend, we need to encourage people to use condoms consistently with new and casual partners,” Amato-Gauci said in the release. “Regular tests for syphilis and other sexually transmitted infections should also be part of the parcel, especially if there has been a risk of infection.”

The European CDC also found that congenital syphilis rates and rates of syphilis among women in Eastern Europe have been decreasing since 2005. However, it expressed concern over the likely underreporting of congenital syphilis in several member states and increasing syphilis rates among women in some western EU/EEA countries. – by Joe Gramigna

Disclosure: Amato-Gauci is employed by the European CDC.

    Perspective
    Khalil Ghanem

    Khalil Ghanem

    Shortly (and ironically) after the CDC announced its “National Plan to Eliminate Syphilis” in 1999, the rates of syphilis in the United States started to increase, and nearly 20 years later, they have yet to stop. For the first 14 years, the increases were mainly seen MSM. In the last few years, rates have also increased in women, with parallel increases in congenital syphilis cases (a shameful public health calamity). We now have two epidemics in the U.S.: one in MSM, and another among heterosexuals linked to drug use. Similar trends have been observed elsewhere around the world. Here is yet another report of increasing syphilis rates from 23 European countries. The majority of cases have been in MSM, but some of the countries in Western Europe have now started to detect increases in women.

    We know how to control syphilis: find infectious cases, treat them, find and treat their partners, screen people at risk and educate the public. So why are we failing miserably? Many factors are cited: Screening rates, even in the highest risk groups, are woefully inadequate; partner notification has become much more challenging in the geospatial app era (it is hard to trace partners who are met online) and high-risk behaviors appear to be increasing. The major reason, however, is a more pedestrian one: the lack of adequate resources specifically allocated to combat this infection. It is going to take a lot of money, folks, and the longer we wait, the more money it is going to take. In the meantime, clinicians should be aggressive in screening for this infection and should become familiar with its sequelae: neurologic, ocular, optic and congenital. It is not pretty, and sadly, it is likely not going to end soon. 

    • Khalil Ghanem, MD, PhD
    • Associate professor of medicine
      Johns Hopkins University School of Medicine

    Disclosures: Ghanem reports no relevant financial disclosures.