Epidemiology of syphilis in Bulgaria, 1990–1998

Dencheva, R; G, Spirov; Gilina, K; Niagolova, D; Pehlivanov, G; Tsankov, Nikolaï; Waugh, Michael

doi:10.1258/0956462001915200

Cited by 6 publications

(5 citation statements)

References 4 publications

(4 reference statements)

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“…Yet, many countries have been reluctant to embrace WHO policies perceived to be designed for developing countries 17. In Bulgaria, there was a sevenfold increase in reported syphilis cases between 1990 and 1994 18 19. STI treatment could officially only be offered at government-controlled dermatovenereological centres.…”

Section: Introductionmentioning

confidence: 99%

Optimising the management of vaginal discharge syndrome in Bulgaria: cost effectiveness of four clinical algorithms with risk assessment

Cornier

Petrova²,

Cavailler³

et al. 2010

Sexually Transmitted Infections

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Objectives To evaluate the performance and cost effectiveness of the WHO recommendations of incorporating risk-assessment scores and population prevalence of Neisseria gonorrhoeae (NG) and Chlamydia trachomatis (CT) into vaginal discharge syndrome (VDS) algorithms. Methods Non-pregnant women presenting with VDS were recruited at a non-governmental sexual health clinic in Sofia, Bulgaria. NG and CT were diagnosed by PCR and vaginal infections by microscopy. Risk factors for NG/CT were identified in multivariable analysis. Four algorithms based on different combinations of behavioural factors, clinical findings and vaginal microscopy were developed. Performance of each algorithm was evaluated for detecting vaginal and cervical infections separately. Cost effectiveness was based on cost per patient treated and cost per case correctly treated. Sensitivity analysis explored the influence of NG/CT prevalence on cost effectiveness. Results 60% (252/420) of women had genital infections, with 9.5% (40/423) having NG/CT. Factors associated with NG/CT included new and multiple sexual partners in the past 3 months, symptomatic partner, childlessness and $10 polymorphonuclear cells per field on vaginal microscopy. For NG/CT detection, the algorithm that relied solely on behavioural risk factors was less sensitive but more specific than those that included speculum examination or microscopy but had higher correct-treatment rate and lower over-treatment rates. The cost per true case treated using a combination of risk factors, speculum examination and microscopy was €24.08. A halving and tripling of NG/CT prevalence would have approximately the inverse impact on the cost-effectiveness estimates. Conclusions Management of NG/CT in Bulgaria was improved by the use of a syndromic approach that included risk scores. Approaches that did not rely on microscopy lost sensitivity but were more cost effective.

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Section: Introductionmentioning

confidence: 99%

Optimising the management of vaginal discharge syndrome in Bulgaria: cost effectiveness of four clinical algorithms with risk assessment

Cornier

Petrova²,

Cavailler³

et al. 2010

Sexually Transmitted Infections

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“…Bulgaria has a large Roma population and also has experienced recent sharp increases in rates of STDs. The prevalence of syphilis in Bulgaria rose dramatically between 1990 and 1998, from fewer than 5 cases to 33 cases per 100,000 of population 7 . HIV rates in Bulgaria have also shown a recent increase.…”

Section: Introductionmentioning

confidence: 99%

High levels of sexual HIV/STD risk behaviour among Roma (Gypsy) men in Bulgaria: patterns and predictors of risk in a representative community sample

et al. 2002

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Studies on HIV and STD risk factors among vulnerable minority groups in Eastern Europe are underrepresented in the literature. The rapid increase in HIV and STD rates observed throughout the region may quickly affect impoverished, stigmatized, and underprivileged communities. Roma (or Gypsies) constitute such a vulnerable group. A total of 324 men aged 14-37 years were recruited during June-July 2001 in a Roma community neighbourhood in Sofia, Bulgaria. HIV/STD risk behaviours were widespread. Men reported a mean of 2.4 female partners in the past 3 months and 77% did not use a condom during their most recent vaginal intercourse. 72% of Roma men said they had engaged in anal intercourse with women in the past 3 months and almost 75% of these heterosexual anal intercourse occurrences were unprotected. 27% reported having sex with other men during their lifetimes, 10% had same-sex anal intercourse partners in the past 3 months, and 58% of the most recent anal intercourse acts by these men were not condom-protected. 16% of men reported selling sex, and 32% paid someone for sex. Positive condom-use attitudes, intentions, norms and self-efficacy, as well as younger age and condom availability, were factors associated with lower sexual risk. These factors should be targeted in rapid, comprehensive, and culturally sensitive prevention interventions for Roma communities.

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“…Heterosexuals, HIV-positive persons, migrants, and pregnant women are also described as risky. The syphilis incidence in Bulgaria maintained a stable frequency rate during the time interval studied, with a tendency to increase in recent years (9). A real increase in the incidence rate in Bulgaria was observed after 1990, when major political, social, and economic changes took place.…”

Section: Discussionmentioning

confidence: 72%

“…However, slightly more cases of women were registered from 2011 to 2014. The distribution of syphilis cases by sex in Bulgaria shows a slight predominance of men, with the trend from 2017 to an increase in cases among women (9,10). Gender dynamics are also observed in other European countries.…”

Section: Discussionmentioning

confidence: 80%

Syphilis in the Pleven region, Bulgaria: a retrospective study

Haydudova

Gospodinov

Karcheva

2020

Acta Dermatovenerologica Alpina Pannonica Et Adriatica

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Introduction: Syphilis is a sexually transmitted infection whose significance to public health has not lost its relevance. Changes in the epidemiology of the disease have been observed in the last decade. This study describes syphilis trends in the Pleven region (Bulgaria). Methods: Data from 2009 to 2018 were extracted from the National Center for Public Health and Analyses in Sofia and the Regional Health Inspectorate in Pleven and analyzed. Results: There were 3,602 cases of syphilis during the 10-year period in Bulgaria. The incidence rate (per 100,000) during the period observed varied from 4.2 in 2011 to a maximum rate of 7.5 in 2017. For the same period, 119 cases of syphilis were reported in the Pleven region, with highest incidence rate registered in 2009 (7.2), and the lowest rate registered in 2014 (2.6). The disease was more common in men. All ages are affected, but the largest group is 25 to 29 years old. During the study period, 219 cases of congenital syphilis were registered in the country, three of them in Pleven region. Conclusions: Retrospective observational data confirmed a rising trend in syphilis cases, especially among younger people. Further study of risk groups and the expansion of promotional activities among adolescents is needed.

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Epidemiology of syphilis in Bulgaria, 1990–1998

Cited by 6 publications

References 4 publications

Optimising the management of vaginal discharge syndrome in Bulgaria: cost effectiveness of four clinical algorithms with risk assessment

Optimising the management of vaginal discharge syndrome in Bulgaria: cost effectiveness of four clinical algorithms with risk assessment

High levels of sexual HIV/STD risk behaviour among Roma (Gypsy) men in Bulgaria: patterns and predictors of risk in a representative community sample

Syphilis in the Pleven region, Bulgaria: a retrospective study

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