Published: 06.10.05 Updated: 06.10.2005 11:46:26
Hans Blystad, Lars Blad, Johan Giesecke, Swedish Institute for Infectious Disease Control, Sweden, the Steering Group of the Project Building a Network for Infections Disease Surveillance in the Baltic Sea Region
Syphilis is a notifiable disease in all the countries in the region. In the Nordic countries and Germany cases are reported anonymously.
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.
In the Nordic countries and Germany syphilis has for many years been a rare disease. However, during the last few years a slight increase has been noted in many Nordic countries mostly due to outbreaks among men who have sex with men. The situation has been very different in Northwest Russia. In the early 1990s all regions of Northwest Russia experienced record high incidence rates for syphilis. The reason seems to be political and social changes, resulting in changing sexual behaviour and delays in treatment that cause patients to remain infectious for longer periods. The Baltic countries are in an intermediate category with increasing incidence rates during the early 1990s, but not to the same extent as their Russian neighbours. The syphilis epidemic in the eastern part of the region reached its peak around 1995-96, but incidence rates remain much higher in the eastern part compared with the western part of the region. Levels of reported cases of syphilis in Poland have been stable and relative low in recent years.
Men who have sex with men are particular at risk of acquiring syphilis in many countries in the western part of the region. In Finland, an increasing number of cases have been reported among heterosexuals along 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 and the unemployed. In Russia, increasing numbers of infections occur among pregnant women, with resulting increase in reported congenital syphilis.
Condom availability, contact tracing and risk information are important elements in the preventive strategy in all the countries in the region. Campaigns with information, intensified contact tracing and improved access to condoms in the present outbreak among men who have sex with men in the Nordic countries have so far had limited success.