Syphilis Infections Continue to Rise in Europe

Incidence of syphilis is on the rise in Europe—particularly among men—according to a report released in May by the European Centre for Disease Prevention and Control (ECDC).

In evaluating data from 29 member nations of the European Union (EU), the ECDC found that there were more than 24,500 cases of the sexually transmitted infection (STI) across the continent in 2014, the most recent year for which data were available, a rate of 5.1 cases per 100,000 persons. This marked an increase of nearly 33% over 2010 figures, which reported more than 18,900 cases across the EU, for a rate of 4.1 cases per 100,000 persons.

Interestingly, the highest infection rates were reported in Malta (11.5 cases per 100,000), Lithuania (8.7), Iceland (7.7), and Spain (7.7), while in nations such as Croatia, Cyprus, Greece, Italy, and Slovenia, rates were below 2.5 cases per 100,000 persons.

Overall, European men were much more likely to be diagnosed with syphilis (8.3 cases per 100,000) than women (1.3 cases per 100,000). Ratios of male-to-female cases above 10 to 1 were reported by France, Germany, Ireland, the Netherlands, Norway, and the United Kingdom, while six countries reported male-to-female ratios below 2 to 1 (Cyprus, Finland, Latvia, Lithuania, Romania, and Slovakia). The ECDC notes that the male-to-female ratio of cases across the continent has “increased continuously,” from 2.5 to 1 in 2005 to 6.2 to 1 in 2014.

Although information on transmission was available for only 67% of the total cases, the ECDC report found that 63% of these cases were reported among men who have sex with men versus 24% for heterosexual transmission. Data on the HIV status of reported syphilis cases was available for only 11 countries and, of these, 29% were HIV positive (either known or newly diagnosed). The majority of cases were reported as primary syphilis (30%), secondary syphilis (27%), or early latent infection (35%).

According to the ECDC, those 45 years of age and older represented the largest segment (30%) of reported cases, although those between 25 and 34 years of age and 25 and 44 years of age weren’t far behind (29% and 27%, respectively). According to the report, “young adults” (those 15 to 24 years of age) accounted for 13% of all reported cases.

In their concluding remarks, the authors of the ECDC report write that, “The number and rate of reported syphilis cases has continued to increase in 2014… The concomitant rise in the trend for gonorrhea, HIV, lymphogranuloma venereum, and cases of sexually transmitted enteric STI suggest that high-risk behavior is increasing, possibly in the context of HIV sero-adaptive behaviors. This is particularly relevant when considering the high proportion of HIV coinfections. The introduction of pre-exposure prophylaxis for HIV might also affect trends in the future due to changing sexual behavior and increased testing for sexually transmitted infections as part of client management pathways.”

Brian P. Dunleavy is a medical writer and editor based in New York. His work has appeared in numerous healthcare-related publications. He is the former editor of Infectious Disease Special Edition.