Syphilis epidemiology in Norway, 1992-2008: resurgence among men who have sex with men.

Irena Jakopanec,Preben Aavitsland,Andrej M Grjibovski,Øivind Nilsen

doi:10.1186/1471-2334-10-105

Abstract

BackgroundIn recent years, the number of syphilis cases has stabilised in many countries of Western Europe, however several countries have reported increases among men who have sex with men (MSM). The aim of this article was to describe the epidemiology of early syphilis in Norway in 1992-2008.MethodsCases of early syphilis and congenital syphilis reported to the Norwegian Surveillance System for Communicable Diseases (MSIS) 1992-2008 were described by route of transmission, gender, age, birthplace, stage of disease, HIV co-infection, source partner and place of infection.ResultsThe incidence of reported syphilis ranged from 0.05 (1992) to 1.50 (2002) per 100 000 person-years. Of 562 cases reported to MSIS during the study period, 62% were men infected by another man. The proportion of those, infected homosexually increased from 0 (1992-1994) to 77% (2008). Most of them were Norwegians (83%). The proportion of HIV co-infection among homosexually infected increased over time and reached 39% in 2008. The majority reported being infected by a casual partner (73%) and in the municipality of Oslo (72%). Of 152 heterosexually infected men 64% were Norwegians; 51% were infected by casual contacts and 20% by commercial sex workers; 73% were infected abroad. Among 56 women, 57% were Norwegians, 57% were infected by a steady partner and 40% were infected abroad. Almost half (46%) were diagnosed in the early latent stage. Four cases had congenital syphilis, two of whom were adopted from abroad.ConclusionsSyphilis is rare in Norway, but MSM represent almost two thirds of cases. The increase of HIV co-infected cases among MSM may enhance transmission of both infections. We recommend sexually active MSM to be tested for syphilis 2-4 times a year. Due to its variable clinical course, syphilis might be difficult to recognise at an early stage among women in a low-prevalence population. We estimate current practice of prenatal screening in Norway as sufficient.

Highlights

In recent years, the number of syphilis cases has stabilised in many countries of Western Europe, several countries have reported increases among men who have sex with men (MSM)
Following increases in the early 2000s in Western European countries, the number of reported syphilis cases has recently stabilised; many countries reported a high proportion of homosexually acquired syphilis (France, Denmark, Ireland, Germany, UK, Sweden, Netherlands) [1]
Using data from the Norwegian Surveillance System for Communicable Diseases (MSIS), we describe the epidemiology of early syphilis in Norway from 1992-2008

Summary

Introduction

The number of syphilis cases has stabilised in many countries of Western Europe, several countries have reported increases among men who have sex with men (MSM). The aim of this article was to describe the epidemiology of early syphilis in Norway in 1992-2008. Following increases in the early 2000s in Western European countries, the number of reported syphilis cases has recently stabilised; many countries reported a high proportion of homosexually acquired syphilis (France, Denmark, Ireland, Germany, UK, Sweden, Netherlands) [1]. Uncertain stage in asymptomatic patients with unknown duration of infection is an important limitation of early syphilis (i.e. primary, secondary and early latent syphilis) surveillance. Using data from the Norwegian Surveillance System for Communicable Diseases (MSIS), we describe the epidemiology of early syphilis in Norway from 1992-2008

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