The resurgence of syphilis in high-income countries in the 2000s: a focus on Europe

Abstract

Syphilis can cause severe complications and sequelae. Following a decrease in reported cases in European Union/European Economic Area (EU/EEA) and other high-income countries in the 1980s and 1990s as a result of the HIV epidemic and ensuing changes in sexual behaviour, trends started to increase in the 2000s in a number of EU/EEA Member States with higher rates among men and a large proportion of cases reported among men who have sex with men (MSM), particularly HIV-positive MSM. Trends in EU/EEA Member States vary however with some countries continuing to report decreases in the number of reported cases (mostly in the Eastern part of EU/EEA) whereas many Western European countries report increasing numbers of cases. Increasing rates among women, although still relatively low, have been observed in a number of countries leading to concerns around mother-to-child transmission of syphilis and congenital syphilis. Similar overall trends are observed in other high-income countries with the exception of Japan where rates among heterosexual men and women have been rising at alarming levels. Control of syphilis requires use of comprehensive, evidence-based strategies which take into account lessons learned from previous control efforts as well as consideration of biomedical interventions.

Keywords: Epidemiology; surveillance; syphilis (T. pallidum infection).

Fig. 1.

Rate of confirmed syphilis cases per 1 00 000 population by gender and year, EU/EEA countries reporting consistently, 2007–2016 (from [13]).

Fig. 2.

Changes in number of reported syphilis cases overall and among men and women, between 2010 and 2016 (adapted from [14]).

Fig. 3.

Number of confirmed syphilis cases by gender, transmission mode (sexual orientation) and year, EU/EEA countries reporting consistently, 2010–2016 (from [13]).