Syphilis epidemiology in Sweden: re-emergence since 2000 primarily due to spread among men who have sex with men

Abstract

E U ROSU R V E I L L A N C E Vol . 13 · I ssu e 50 · 11 D ecemb er 20 08 · w w w. e urosurve illance. o rg 1 S u r v e i ll a n c e a n d o u t b r e a k r e p o r t s S y p h i l i S e p i d e m i o l o g y i n S w e d e n : r e -e m e r g e n c e S i n c e 2 0 0 0 p r i m a r i ly d u e t o S p r e a d a m o n g m e n w h o h av e S e x w i t h m e n I Velicko (inga.velicko.smi.se) Syphilis has re-emerged in western Europe since 2000. Changes in sexual behaviour have facilitated the spread of syphilis especially among men who have sex with men (MSM) and improved surveillance systems and case detection have lead to an increase in the reported numbers of cases. This report describes recent trends (2000)(2001)(2002)(2003)(2004)(2005)(2006)(2007) of syphilis in Sweden, where the spread among MSM, particularly in the big cities, has been a major contributor to an increase in cases. Estimated syphilis incidence among MSM was up to twenty-eight times higher than in the general Swedish male population. The most affected age group among males was 25-44 years of age. The majority of infections in men and women through heterosexual contacts were acquired abroad whereas the majority of infections attributed to sex between men were acquired in Sweden. Appropriate prevention activities are needed to reach vulnerable populations in Sweden.

Increase in reported gonorrhoea cases in Sweden, 2001 - 2008

“…This correlates well with the reported syphilis cases in Sweden [9], suggesting that cities with a large population provide an environment where free sexual behaviour is more readily accepted. In addition, sexual networks tend to be larger in the cities and the chances of contact with risk groups for STI transmission are higher.…”

“…Gonorrhoea is a notifiable infection in Sweden, in accordance with the Swedish Communicable Diseases Act, and the present surveillance system has been described elsewhere [2,9]. The gonorrhoea case definition used in Sweden since 1997 includes any person meeting the laboratory criteria.…”

Syphilis: The Renaissance of an Old Disease with Oral Implications

“…In the USA, the incidence of syphilis continued to cycle reaching an all time low in 2000, with 2.1 cases per 100.000 persons [17]. During the last 8 years a significant resurgence of this disease has been reported in several countries such as the USA, Canada, England, France, Spain, Ireland, Eastern Europe, Russia and China [6][7][8][9][10][11][12][13][14][15][16][17][18][19][20][21][22][23][24]. Main epidemiology changes, at the basis of increasing prevalence, reflect sex industry, sexual promiscuity, decreasing use of barrier protection (i.e.…”

“…In the USA, in the first half of the twentieth century, syphilis was a frequent infection (66.4 cases per 100.000 persons in 1947) and a leading cause of heart and neurological diseases [3,6,9]. In 1940s the introduction of penicillin therapy and prevention efforts made the disease rare.…”

“…Despite the introduction, in the mid-twentieth century, of penicillin it has been impossible to eradicate this disease and it remains a relevant problem among the ailments of mankind and its incidence is rapidly increasing in several parts of the world [6][7][8][9].…”