Published: 09.02.05 Updated: 09.02.2005 18:05:44
Syphilis is a notifiable disease in the entire region. In Norway and Sweden cases are reported anonymously using a non-unique identifier. Norway only report infectious (primary, secondary and early latent) syphilis, while in the other countries all syphilis stages or all positive serological tests are reported. All the countries report only laboratory confirmed cases. Due to an increase in private and informal health systems, the number of non-reported cases in Russia has probably increased during the last few years.
Figure 12. Number of cases of syphilis notified in 2003 per 100 000 population (1).
The incidence of syphilis in the Nordic countries was greatly reduced in the 1980s and 1990s. Most of these cases were heterosexuals who acquired their infection abroad. Since the late 1990s, the situation has worsened in Denmark, Norway and Sweden due to increased incidence among men who have sex with men. Syphilis seems now once again to be endemic in this group. A high proportion (20-30%) of the gay men acquiring syphilis during the last few years was HIV positive (14).
Figure 13. Number of cases of syphilis notified per 100 000 population 1999- 2003 by groups of countries or regions (1). Komi, Pskov, Novgorod and Vologda regions not included.
The situation has been very different in Northwest Russia and the Baltic countries. In the early 1990s, Northwest Russia and the Baltic countries experienced record high incidence rates for syphilis. The reason for this seems to be political and social changes, resulting in changing sexual behaviour and delays in treatment that caused patients to remain infectious for longer periods. The syphilis epidemic in the eastern part of the region reached its peak around 1995-96, and the incidence rates are still dropping (figure 13). The proportion of self presenting cases versus cases detected through screening has declined. Incidence rates are still much higher in the eastern part compared with the western part of the region. In Finland, an increasing number of cases have been reported among heterosexuals living close to the Russian border. The overwhelming majority of cases in the Baltic countries and Northwest Russia are among heterosexuals with a high number of cases among the young, the unemployed, substance abusers and sex workers. A study from 2000 where blood left inside syringes handed in at a syringe exchange programme in St. Petersburg were tested for treponemal antibodies, showed that 6.9% of the blood samples were positive (8). A prevalence study in 2002 among drug users in St. Petersburg showed that 12% had syphilis seromarkers, and that positive markers was nine times higher in females than in males, and strongly associated with sex work (15). In Russia, increasing numbers of infections occur among pregnant women, with resulting increase in reported congenital syphilis.
Condom availability, easy access to testing sites, contact tracing and risk information are important elements in the preventive strategy in all the countries in the region. NGOs have in the Nordic countries played an important role in the outreach activity and prevention among men who have sex with men.
Different screening programmes have been developed for different risk groups in the region. While voluntary screening in the western part of the region is restricted to pregnant women and risk groups like men who have sex with men, much more extensive screening programmes remain in Northwest Russia, like screening of non high risk groups like health care workers and food handlers.