Eurosurveillance

ECDC

Gonorrhoea and syphilis form Russia to Norway, 1993-1999

 Rediger
 1 Published: 24.05.05 Updated: 24.05.2005 13:41:18
Preben Aavitsland, National Institute of Public Health, Norway

In Norway, there are concerns of a spread of the Russian epidemics of gonorrhoea and syphilis to Norway, especially to neighbouring Finnmark county. For the years 1993 - 1999, the Norwegian surveillance system for communicable disease revealed that 29 gonoorhoea cases ( 2% of total ) were linked to Russia. There was no time trend for either disease. Eleven gonorrhoea and three syphilis cases was from Finnmark. Most patients were males over 30 years og age. So far, the gonorrhoea and syphilis epidemics in Russia have had minor influence in Norway. Thorough surveillance is still needed.

Introduction

In the 1990s, Russia experienced a rapidly increasing incidence of syphilis and gonorrhoea (1,2). The causes seem to be changing sexual behaviour and delays in diagnosis and treatment causing the patients to remain infectious for longer times.

The epidemics have also reached the Russian part of the Barents region, including Murmansk oblast. In Norway, there are concerns of a spread of the Russian epidemics to Norway, especially to neighbouring Finnmark county where many men engage in sexual relations with women who cross the border from Murmansk oblast. These relations range from pure prostitution through shortlasting love affairs to marriages.

In contrast to Russia, Norway has in the 1990s experienced a continuation of the decreasing incidence of gonorrhoea and syphilis. The positive trends are usually ascribed to widespread diagnosis and treatment offered by the public health system.

In this article, I will use data from the Norwegian surveillance system for communicable diseases.

Methods

Since 1993, new cases of gonorrhoea and syphilis have been reported anonymously to the Norwegian surveillance system for communicable diseases (3). The microbiological laboratories initiate reporting by sending the reporting form to the clinician together with the positive result of the laboratory examination. At the same time, the laboratory reports the case to the National Institute of Public Health (NIPH). The clinicians give detailed epidemiological data in the anonymous reporting forms which are computerised at NIPH. The system has a coverage of more than 90% of the laboratory-confirmed cases. Clinicians are instructed always to get laboratory confirmation of gonorrhoea and syphilis, and these laboratory investigations are free of charge for the patients and the clinicians.

In the seven year period from 1993 through 1999, 1506 cases of gonorrhoea and 111 cases of early syphilis were reported. By early syphilis we mean primary, secondary and early latent cases.

From the database at NIPH, we selected cases from the following three groups: 1) Norwegians infected in Russia, 2) Norwegians infected by Russians in Norway, and 3) Russians diagnosed in Norway.
We studied year of diagnosis, age, sex and county of residence or diagnosis.

Results

In the seven-year period, 1993-1999, 29 gonorrhoea cases, that is 2% of the total, had links to Russia. There was no obvious time trend over the period (fig 1).

Figure 1 Gonorrhoea cases with links to Russia, diagnosed in Norway 1993-1999

The last two years, only two cases have been linked to Russia. Fifteen of the cases were Norwegians infected by casual partners or prostitutes in Russia (table1). Fourteen of these fifteen Norwegians were males aged between 24 and 59 years. Six of them lived in Finnmark and three in other parts of Northern Norway. Seven men, of whom five lived in Finnmark, were infected by Russian women in Norway. Seven Russians have had gonorrhoea diagnosed in Norway.

Table 1. County distribution of cases of gonorrhoea with links to Russia, diagnosed in Norway 1993-1999

County

Norwegians infected in Russia

Norwegians infected by Russians in Norway

Russians diagnosed in Norway

 

Men

Women

Men

Women

Men

Women

Finnmark

6

0

5

0

0

0

Troms and Nordland

3

0

0

0

1

2

Other counties

5

1

2

0

4

0

Total

14

1

7

0

5

2

In the seven-year period, 12 syphilis cases, that is 11% of the total, had links to Russia. There was no obvious time trend over the period (fig 2).

Figure 2. Numbers of syphilis cases with links to Russia, diagnosed in Norway 1993- 1999.

The last year, no case was linked to Russia. Six of the cases were Norwegians infected by casual partners or prostitutes in Russia (table 2). All these six Norwegians were males, aged between 32 and 47 years. Two of them lived in Finnmark and one in another part of Northern Norway. Two men, of whom one lived in Finnmark, were infected by Russian women in Norway. Four Russians have had syphilis diagnosed in Norway.

Table 2. County distribution of cases of syphilis with links to Russia, diagnosed in Norway 1993-1999

County

Norwegians infected in Russia

Norwegians infected by Russians in Norway

Russians diagnosed in Norway

 

Men

Women

Men

Women

Men

Women

Finnmark

2

0

1

0

0

0

Troms and Nordland

1

0

0

0

2

1

Other counties

3

0

1

0

0

1

Total

6

0

2

0

2

2

Discussion

Every year, less than ten cases of gonorrhoea and syphilis can be linked to Russia, and the situation seems stable. The reason for this limited spread from Russia to Norway may be that Norwegians and Russians do not engage in sexual relations with each other. Alternatively, it may be that these sexual relations are protected by condom use. However, it may also be that those Russians who engage in sex with Norwegians are not infected. For instance, most of the Murmansk women who meet sex partners in Finnmark, are not prostitutes in Russia. Thus, they may not be at very great risk of getting gonorrhoea or syphilis in Murmansk. In fact, they may be at larger risk of getting infected in Finnmark.

Epidemics of gonorrhoea and syphilis are markers of behaviour that may increase the spread of HIV. In addition, gonorrhoea and syphilis increase the infectiousness of HIV. Thus, we can expect an increasing epidemic of HIV-infection in Russia in the near future. Thus, close surveillance of these diseases both in Russia and Norway seems necessary.

The successful eradication campaigns for gonorrhoea and syphilis in Norway may bring some lessons for other countries, including Russia. Norwegian public health officials may work with Russian counterparts to combat sexually transmitted infections in the Barents region.

(This article is an extension of an article published in Norwegian previously (4).)

Literature

  1. Tichonova L, Borisenko K, Ward H, et al. Epidemics of syphilis in the Russian Federation: trends, origins, and priorities for control. Lancet 1997; 350: 210-213.
  2. Renton A, Ward H, Meheus A. Epidemiology, control and surveillance of syphilis and gonorrhoea in the Russian Federation. Copenhagen: WHO, 1997.
  3. Aavitsland P, Nilsen Ø. A new anonymous case reporting system for sexually transmitted diseases in Norway. Nor J Epidemiol 1995; 5: 39-43.
  4. Aavitsland P. Gonoré og syfilis fra Russland til Norge. Tidsskr Nor Laegeforen 1999; 119: 1487-1489.

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