A new study on syphilis has revealed the horrifying truth that more men than ever are contracting the sexually transmitted infection (STI) syphilis in Europe. The most heavily infected group comprises men having sex with men (MSM). At present, syphilis affects more people than HIV in the European Union.
The new European Centre for Disease Prevention and Control (ECDC) study shows that in 2017 alone, over 33,000 new cases were notified, which is the peak figure since ECDC surveillance began. In 2010, syphilis incidence was lowest, at 19,000 cases, but since then, its incidence has been rising steadily across most European countries. There are now 260,000 confirmed cases.
Treponema pallidum Syphilis bacterium, the bacterium responsible for the dangerous sexually transmitted infection syphilis. Image Credit: royaltystockphoto.com / Shutterstock
In other words, while the disease affected about 4.2 per 100,000 population in 2010, it zoomed up to 7.1/100,000 in 2017, an increase of 70%. An increase of over 15% has been reported by 15 countries. In five states, it increased by 100% or more, namely, Iceland, Ireland, the UK, Germany and Malta. Iceland, indeed, reported a rise of over 850%. The trend was reversed in Estonia and Romania where the rates dropped to half or less over the same period.
It is both easy and cost-effective to treat syphilis, but if ignored, it can cause severe complications and also encourage HIV infection. Moreover, syphilis during pregnancy can affect the fetus in many ways, from fetal loss to congenital syphilis in the baby.
Who are most affected?
More men than women got the disease, with 12.1 men per 100,000 being affected in 2017 as against 6.1/100,000 in 2010. Over the 17 years since 2000, 62% of cases, or almost two-thirds, occurred in MSM, with women contributing 15% and heterosexual men 23%. MSM accounted for 80% of syphilis cases in countries like France, Germany, Ireland, the UK, the Netherlands and Sweden, while less than a fifth was contributed by this group in Eastern European countries like Latvia and Lithuania.
However, one bright spot is that fewer babies are being born with congenital syphilis since 2005, which is linked to the lower number of cases of syphilis among women especially in Eastern Europe. In many other high-income parts of the world (e.g., the US and Japan), congenital syphilis continues to rise in keeping with a rising trend among women. When taken individually, however, it is clear that many western European states have rising rates of syphilis among women.
ECDC Head for HIV, STI and viral hepatitis, Andrew Amato-Gauci, commented on the clear link between the risk of STIs like syphilis, and high-risk sexual behavior among MSM, such as condom-less intercourse and having multiple sexual partners. He also stated that the fear of getting HIV had declined with the use of pre-exposure prophylaxis (PrEP), which also contributed to the rising trend of syphilis. The free availability of partners for sex using social media was an important factor in many recent outbreaks among MSM.
In heterosexual groups, some identified factors included low socioeconomic status as identified by homelessness, migrant or refugee status, minority status, a history of imprisonment and poverty; sex-activity related, such as failure to use condoms, multiple partners for sex, drug and alcohol use, previous STIs, and sex worker profession.
What can be done?
Amato-Gauci offers some solutions: “To reverse this trend, we need to encourage people to use condoms consistently with new and casual partners. Regular tests for syphilis and other sexually transmitted infections should also be part of the parcel, especially if there has been a risk of infection.”
In most other medical conditions, such as cardiovascular disorders, effective remedial measures are designed to modify the damaging high-risk behavior, whether in terms of dietary measures or a more active and serene lifestyle. When it comes to STIs, however, fire-fighting seems to be the mode of intervention in vogue, as against targeting the damaging behavior of unrestricted sexual activity, that puts the health of both current and future generations at risk.
The ECDC-recommended interventions include:
- Case finding by examining risks at high group, partner notification and increased surveillance
- Proper treatment
- Educating people about the risk of syphilis, including high-risk groups, and healthcare providers
- Repeat screening of pregnant women at high risk of syphilis between 28 and 32 weeks if they have initially tested negative
- Online social media-based platforms for STI testing
- Pre- and post-exposure prophylaxis
- Comprehensive management of outbreaks
- Preventing congenital syphilis by repeated antenatal testing in high-risk women