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

G Spiteri,A J Amato-Gauci,M Unemo,O Mårdh

doi:10.1017/s0950268819000281

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.

Highlights

Syphilis is caused by the spirochaete Treponema pallidum subspecies pallidum
The aim of this review was to describe the recent epidemiology of syphilis in high-income countries, focusing on the European Union and the European Economic Area (EU/EEA) and Downloaded from https://www.cambridge.org/core
The resurgence of syphilis over the last decade in high-income countries of EU/EEA has clearly been driven by epidemics among men who have sex with men (MSM)

Summary

Introduction

Syphilis is caused by the spirochaete Treponema pallidum subspecies pallidum. The infection is mainly sexually transmitted, except for transfusion of blood or blood products and congenital syphilis (mother-to-child transmission (MTCT) of syphilis), which is transmitted vertically during pregnancy. Syphilis may present as a chancre (primary syphilis) 10–90 days (average 3 weeks) after exposure [1]. The chancre will heal, but within a few weeks or months symptoms of secondary syphilis may appear. Symptoms of secondary syphilis disappear within some weeks, even without treatment. Latent syphilis follows where patients do not show any symptoms but may remain infectious for up to a year following infection [2]. Latent infection may last for decades; if untreated, tertiary syphilis may develop with symptoms depending on the organ involved. Neurosyphilis, can still be observed and may present at any stage of syphilis. Benzathine penicillin G is the recommended treatment for syphilis and no bacterial resistance has been confirmed yet [3,4,5,6]

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