Abstract
In Germany, the number of reported syphilis cases increased between 11% and 22% per year between 2010 and 2014. We analysed syphilis surveillance data and data of four behavioural surveys on men who have sex with men (MSM) in Germany (2003, 2007, 2010, 2013) to assess if this rise is ongoing and to find possible explanations for it. Syphilis notifications increased in 2015 by 19% to a total of 6,834. This was mainly due to increasing notifications in MSM of all age groups in larger German cities. Data from the behavioural surveys on MSM in Germany showed a simultaneous increase of selective condom use as HIV-status-bases risk management strategy and the number of syphilis cases. MSM diagnosed with HIV reported condomless anal intercourse with non-steady partners more frequent than MSM not diagnosed with HIV or untested for HIV, but the latter also reported higher frequencies of this behaviour in the more recent surveys. Transmission in HIV-positive MSM probably plays an important, but not exclusive role, for the syphilis dynamics in Germany. A risk adapted routine screening for sexually active MSM and potentially innovative approaches to increase early screening and treatment of syphilis such as internet counselling, home sampling, home testing and broadening venue-based (rapid) testing, should be critically evaluated to effectively reduce syphilis infections.
Highlights
Syphilis incidence among men who have sex with men (MSM) has been on the rise globally during the last years
The following numbers of MSM participated in the behavioural surveys: 2003 (n = 1,039), 2007 (n = 1,315), 2010 (n = 8,242), 2013 (n = 1,547)
The transmission route was reported for 75.6% of cases (n = 5,166); of these, 84.7% occurred in MSM, 15.0% among heterosexual persons, and 0.3% were acquired through other routes of transmission
Summary
Syphilis incidence among men who have sex with men (MSM) has been on the rise globally during the last years. In western countries, sharp increases in numbers of syphilis infections were observed [1,2,3,4]. In Europe, the syphilis incidence was 5.1 cases/100,000 inhabitants overall, with distinct differences between countries, probably due to the differences in the notification systems, completeness of data and healthcare structures [3]. Since 2009, the syphilis incidence increased in Europe in men, especially in western European countries, while the incidence decreased in women concurrently. In Germany, the number of reported syphilis cases doubled between 2001 and 2004 to over 3,000 per year and remained mainly stable until 2009. Between 2010 and 2014, the number increased between 11% and 22% per year [5]
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