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PubMed2001

Absence of risk factors for false-positive test results in blood donors with a reactive test result in an automated treponemal test (PK-TP) for syphilis.

BACKGROUND: Screening and confirmatory serologic tests for syphilis are known to generate false-positive results in low-risk populations, which include blood donors. This study assessed whether conditions previously reported to cause biological false-positive (BFP) test results for syphilis are relevant to contemporary syphilis testing of blood donors and the extent to which seropositive donors report a history of syphilis. STUDY DESIGN AND METHODS: A history of conditions reported to be associated with BFP syphilis tests or a history of syphilis infection was assessed by a case-control study of donors with reactive and nonreactive automated treponemal test results, using an anonymous mail survey. Analysis of cases was stratified by fluorescent treponemal antibody absorption (FTA-ABS) result. RESULTS: Adjusted ORs (95% CIs) for reported BFP-associated conditions were 1.3 (0.8-2.1) for FTA-ABS-positive cases and 0.8 (0.3-1.9) for FTA-ABS-negative cases. Among responding blood donors, syphilis history was reported in 78 (51%) of 153 FTA-ABS-positive cases, 0 of 142 FTA-ABS-negative cases, and 3 (0.4%) of 716 automated treponemal test (PK-TP)-negative controls. CONCLUSION: Approximately half of donors with FTA-ABS-positive test results reported a syphilis history. There was no difference between reported BFP conditions for FTA-ABS-positive or FTA-ABS-negative cases and controls. This information may be useful when providing donors with better predonation or post-test counseling information about syphilis testing.

Adolescent↗

PubMed1994

Incubating syphilis in patients treated for gonorrhea: a comparison of treatment regimens.

Dade County sexually transmitted disease clinic records were reviewed to estimate the relative effectiveness of gonorrhea treatment regimens for eradicating incubating syphilis. Records were searched to see if persons treated for gonorrhea returned with primary syphilis 3-45 days after treatment or secondary syphilis 15-90 days after treatment. The number of persons treated was adjusted for the prevalence of syphilis in the year of treatment. Between 1985 and 1992, 98,441 persons were treated for gonorrhea. Syphilis was diagnosed in an interval that suggested it was incubating at the time of the treatment for 5.6/10(4) (adjusted number) persons treated with spectinomycin alone (a regimen not expected to eradicate syphilis); 2.9/10(4) persons treated with spectinomycin plus tetracycline, doxycycline, or erythromycin; and 2.1/10(4) persons treated with ceftriaxone plus tetracycline, doxycycline, or erythromycin (P > .1). Incubating syphilis was rare despite a syphilis epidemic. The effectiveness of a regimen for eradicating incubating syphilis should not be a major consideration when choosing gonorrhea therapy.

Ceftriaxone↗

PubMed2000

Geographic variation of HIV infection in childbearing women with syphilis in the United States.

OBJECTIVES: Substantial biologic and epidemiologic data indicate the importance of syphilis as a potential cofactor for sexual transmission of HIV infection, but few detailed data exist on the geographic covariation of these two important sexually transmitted infections. DESIGN: HIV prevalence in childbearing women and primary and secondary (P&S) syphilis data from 29 states were examined to explore the importance of the epidemiology of syphilis as a factor in facilitating HIV transmission. METHOD: The spatial relationship between P&S syphilis and HIV infection in the health districts of 29 states was analyzed and adjusted for demographic and socioeconomic factors such as racial composition, income, housing, education levels, and access to medical services using the 1990 US census, and geographic location. RESULTS: In 29 states and the District of Colombia, 448 health districts, representing more than 75% of the US population, reported HIV prevalence rates for mothers' district of residence. The HIV seroprevalence ranged from 0 to 1258/10 000 in these health districts. The incidence of P&S syphilis from 1984-1994 in these districts ranged from 0 to 87/100 000. The P&S syphilis incidence was positively associated with the prevalence of HIV infection among childbearing women (P < 0.0001). CONCLUSIONS: Syphilis that persists in communities in the United States appears to represent a 'sentinel public health event' reflecting risk for sexual HIV transmission. These findings, along with other biologic and epidemiologic information, reinforce the importance of syphilis as an indicator for targeting HIV prevention efforts generally, as well as syphilis control as a specific HIV-prevention strategy.

Confounding Factors, Epidemiologic↗

PubMed1999

The epidemiology of syphilis in the waning years of an epidemic: Houston, Texas, 1991-1997.

BACKGROUND: National and local syphilis rates have fallen since 1990. Accurate epidemiologic information about the distribution of syphilis during the waning years of an epidemic are important to health care organizations so that they can specifically target screening and intervention programs. GOALS: To describe the epidemiology of syphilis in Houston, Texas, from 1991 through 1997. STUDY DESIGN: Descriptive evaluation of morbidity surveillance data from the Houston Department of Health and Human Services. RESULTS: Between 1991 and 1997, rates for syphilis fell 61%. Rates for primary and secondary syphilis fell 90% among men and women in all race/ethnicity groups; early latent rates fell 81% among blacks, 57% among Hispanics, and 50% among whites. Late latent rates were stable among blacks and whites and increased among Hispanics. The proportion of total cases identified as late latent disease increased from 16% in 1991 to 63% in 1997. Congenital syphilis rates have remained at approximately 2 per 1,000 live births since 1993. CONCLUSION: Syphilis continues to be a problem in Houston. The medical community and HIV/STD prevention programs need to be vigilant in actively screening high-risk individuals to identify syphilis at earlier stages of the disease and to prevent congenital syphilis.

Adult↗

PubMed2001

Congenital syphilis and fluorescent treponemal antibody test reactivity after the age of 1 year.

BACKGROUND: Many believe that a persistently reactive fluorescent treponemal antibody absorption (FTA-ABS) is manifested with congenital syphilis after the age of 1 year, that it is useful in the retrospective diagnosis of children with congenital syphilis, and that it can be used to confirm other treponemal tests. GOAL: To determine whether a reactive FTA-ABS after the age of 12 months is indicative of congenital syphilis. STUDY DESIGN: Prospective outpatient follow-up evaluation until at least the age of 12 months was conducted for 194 babies born to mothers with reactive syphilis serology at delivery, and for two additional children with congenital syphilis diagnosed when they were younger than 1 year (total, 196 children). RESULTS: In the study group, 54 children had reactive FTA-ABS (reactors) until the age of at least 12 months or more, and 142 children had nonreactive FTA-ABS (nonreactors) at the age of 12 months or more. Of the 54 reactors, 17 (31%) had evidence of congenital syphilis at birth, whereas evidence of congenital syphilis was seen in 14 of the 142 (10%) nonreactors (P = 0.0002). At 15 months, nonreactive FTA-ABS developed in six reactors, and eventually in 15 of 44 reactors (34%) tested. CONCLUSIONS: A reactive FTA-ABS may be seen at 12 months in children with and without evidence of congenital syphilis at birth. Not all children with congenital syphilis will manifest reactive FTA-ABS at 12 months, and FTA-ABS reactivity wanes with time.

Age Factors↗

PubMed2002

Prevalence monitoring in syphilis surveillance: results from a multicenter research program.

BACKGROUND: Syphilis seroprevalence data can be used as an independent measure of syphilis trends and to augment syphilis case report data for program planning. The prevalence of reactive syphilis serology in jails, delivery rooms, and drug treatment centers was examined from 1995 to 1999. Prevalence was evaluated by age and gender at each site and compared with county primary and secondary syphilis case rates. Annual prevalence of high titer-reactive serology in jails was compared with primary and secondary syphilis case rates. GOAL: The goal was to examine trends in syphilis seroprevalence and to evaluate the relationship of trends in seroprevalence to reported cases. STUDY DESIGN: This was a cross-sectional survey. RESULTS: Prevalence of reactive serology and high titer-reactive serology was lowest among women in delivery rooms (2.9% and 0.4%, respectively) and highest among women in jails (11.1% and 4.1%, respectively), indicating substantial recently treated or active infection among women in jails. Trends in high titer-reactive serology were similar to primary and secondary syphilis case rates. CONCLUSION: The prevalence of high titer-reactive serology can provide valuable information about community syphilis morbidity for use in prevention and control programs.

Adolescent↗

PubMed2003

Partner notification for HIV and syphilis: effects on sexual behaviors and relationship stability.

BACKGROUND: Partner notification (PN), originally designed for syphilis control, has been used to control the spread of HIV since 1985. Because HIV infection is noncurable, the benefit of contact tracing and treatment demonstrated for the control of syphilis may not apply to HIV. For HIV, PN must facilitate behavior change that will reduce the spread of the infection. One concern is that HIV PN can promote the breakup of old partnerships and increase the acquisition of new partners, thereby spreading HIV infections. GOAL: The purpose of this study was to determine the effect of partner notification (PN) on sexual behavior and relationship stability among HIV partnerships, with use of syphilis partnerships for comparison. STUDY DESIGN: Partnerships were eligible if the index case was interviewed by a disease intervention specialist (DIS) for PN and named at least one sex partner. Partnership information was reported by index cases interviewed at baseline and 3 and 6 months post-PN. Trends in partnership dissolution and acquisition, sexual abstinence, condom use, emotional abuse, and physical violence reported by HIV infection and syphilis index cases were compared. RESULTS: A total of 157 index cases (76 HIV infection and 81 syphilis) reported 220 partnerships (94 HIV and 126 syphilis). The PN process was completed for 32.7% of partnerships and it was completed more often for partnerships that were classified as main and cohabiting. After PN, 46.8% of partnerships dissolved, 15.9% of cases acquired a new partner, and emotional abuse and physical violence decreased significantly. HIV index cases were somewhat more likely to report using condoms at last sex act and less likely to acquire a new sex partner after PN compared to syphilis index cases. There was no difference post-PN between HIV infection and syphilis partnerships for partnership dissolution, physical violence, emotional abuse and abstention from sex. CONCLUSION: HIV PN did not appear to cause greater partnership dissolution, new partner acquisition, or violence compared with syphilis PN.

Adolescent↗

PubMed2003

AIDS mortality may have contributed to the decline in syphilis rates in the United States in the 1990s.

BACKGROUND: The mortality associated with AIDS among men may have had an influence on primary and secondary syphilis trends among men in the United States, through the loss of men at high risk for acquisition or transmission of syphilis in this population and/or by prompting safer sexual behaviors in response to the threat of AIDS. GOAL: The goal of this study was to examine the association between AIDS mortality rates and primary and secondary syphilis incidence rates among men in the United States from 1984 to 1997. STUDY DESIGN: We used a fixed-effects regression analysis of state-level AIDS mortality rates and primary and secondary syphilis incidence rates for men. RESULTS: Our analysis showed a significant association between higher AIDS mortality and lower rates of syphilis incidence, after we controlled for confounding factors. Our model estimates suggested that every 20 AIDS deaths per 100,000 adult men are associated with declines of about 7% to 12% in syphilis incidence rates among men. CONCLUSION: Increases in AIDS-associated mortality may have accounted for one-third to one-half of the decline in syphilis rates among men in the early 1990s. Recent declines in AIDS mortality in the United States may have contributed to the recent outbreaks of syphilis, particularly among men who have sex with men. Our findings underscore the importance of providing STD prevention services to men with HIV infection and the need for STD surveillance in communities at risk for syphilis outbreaks.

Acquired Immunodeficiency Syndrome↗

PubMed2005

Social marketing campaign significantly associated with increases in syphilis testing among gay and bisexual men in San Francisco.

BACKGROUND: Between 1999 and 2002, San Francisco experienced a sharp increase in early syphilis among gay and bisexual men. In response, the San Francisco Department of Public Health launched a social marketing campaign to increase testing for syphilis, and awareness and knowledge about syphilis among gay and bisexual men. METHODS: A convenience sample of 244 gay and bisexual men (18-60 years of age) were surveyed to evaluate the effectiveness of the campaign. Respondents were interviewed to elicit unaided and aided awareness about the campaign, knowledge about syphilis, recent sexual behaviors, and syphilis testing behavior. RESULTS: After controlling for other potential confounders, unaided campaign awareness was a significant correlate of having a syphilis test in the last 6 months (odds ratio, 3.21; 95% confidence interval, 1.30-7.97) compared with no awareness of the campaign. A comparison of respondents aware of the campaign with those not aware also revealed significant increases in awareness and knowledge about syphilis. CONCLUSIONS: The Healthy Penis 2002 campaign achieved its primary objective of increasing syphilis testing, and awareness and knowledge about syphilis among gay and bisexual men in San Francisco.

Adolescent↗

PubMed2006

Syphilis treatment and HIV infection in a population-based study of persons at high risk for sexually transmitted disease/HIV infection in Lima, Peru.

OBJECTIVES: The objective of this study was to characterize syphilis epidemiology and the relationship of HIV status and initial rapid plasma reagin (RPR) titer to syphilis treatment in Lima, Peru. STUDY DESIGN: We screened 1,261 individuals at high risk for sexually transmitted diseases for syphilis and HIV infection. Syphilis was treated with penicillin injection or doxycycline; treatment was repeated in unresponsive cases. RESULTS: : The prevalence of syphilis was 7.7%, 1-year incidence rate was 4.7%, and reinfection rate was 42.7%. The treatment success rate was 93.4% (71 of 76); those with initial RPR titers or=1:16. HIV infection was associated with syphilis, prevalent in 15.6% and 3.7% of those with and without syphilis, respectively (P < 0.001), but did not affect treatment success (90.9% vs. 93.8%). CONCLUSIONS: Syphilis was common, associated with HIV infection, and less responsive to therapy in those with initial RPR titers <or=1:8. HIV infection did not affect syphilis treatment success rates.

Adolescent↗

PubMed2005

Use of the serologic testing algorithm for recent HIV seroconversion (STARHS) to identify recently acquired HIV infections in men with early syphilis in Los Angeles County.

BACKGROUND: Syphilis outbreaks among men who have sex with men (MSM) in the United States, many of whom are HIV infected, have prompted increased concern for HIV transmission. METHODS: To identify whether men are acquiring HIV concomitantly or within the critical period of syphilis infection, banked Treponema pallidum particle agglutination-positive serum specimens from men with early syphilis infection were screened for HIV-1 antibody. Samples that were positive for HIV antibody were then tested with a less sensitive (LS) HIV-1 antibody enzyme immunoassay (serologic testing algorithm for recent HIV seroconversion [STARHS]) to identify HIV infections that occurred on average within the previous 6 months. RESULTS: Of the 212 specimens banked from men with early syphilis, 74 (35%) were HIV-positive. Of these, 15 tested non-reactive by the LS assay. Twelve of these 15 were considered to be recent infections by the LS assay and testing history. Eleven (92%) of the recent infections were among MSM. One man had primary syphilis, 6 (50%) had secondary syphilis, and 5 (42%) had early latent syphilis. Eight men (67%) reported sex with anonymous partners, and 3 (25%) reported consistent condom use. The estimated HIV incidence was 17% per year (95% confidence interval [CI]: 12%-22%) among all men with early syphilis, and it was 26% per year (95% CI: 91%-33%) among MSM. CONCLUSIONS: Syphilis epidemics in MSM may be contributing to HIV incidence in this population. The STARHS can be applied as a surveillance tool to assess HIV incidence in various at-risk populations, but further studies are necessary for validation.

Adult↗

PubMed2006

Update on ocular syphilis.

PURPOSE OF REVIEW: The present review updates the reader on publications from the past 5 years relevant to ocular syphilis. RECENT FINDINGS: Articles from this period are easily grouped into three categories: descriptions of syphilitic ocular manifestations, ocular syphilis in the setting of HIV infection, and treatment of syphilitic ocular disease. While all of the entities described were previously recognized, many are unusual and their description in connection with syphilis is a reminder to be vigilant for this uncommon but everpresent disease. Ocular syphilis can be more severe in patients with HIV infection who are not taking highly active antiretroviral therapy, while with this treatment syphilis is an increasingly likely cause of ocular inflammation. Ocular syphilis should be treated like neurosyphilis, with daily intravenous or intramuscular penicillin for 2 weeks. The prevalence of syphilis has increased markedly in the past 5 years, most notably among men who have sex with men. The fluorescent treponemal antibody assay and similar tests remain the appropriate diagnostic tests for syphilis in patients with ocular inflammation. SUMMARY: Syphilis lingers on the differential diagnosis of all forms of ocular inflammation and should be considered when evaluating such patients.

Anti-Bacterial Agents↗

PubMed2005

Antenatal syphilis screening in sub-Saharan Africa: lessons learned from Tanzania.

UNLABELLED: OBJECTIVES; To synthesise data from four recent studies in Tanzania examining maternal syphilis screening and its operational implementation in routine antenatal clinics (ANC), drawing lessons for strengthened antenatal services for the prevention of mother-to-child transmission (PMTCT) of HIV. METHODS: The impact of untreated maternal syphilis was examined in a retrospective cohort of 380 Tanzanian women. Effectiveness and cost-effectiveness of screening and single dose benzathine penicillin treatment were prospectively examined in 1688 pregnant women. Observation, interviews and facility audits were carried out in health facilities within nine districts to determine the operational reality of syphilis screening. RESULTS: Overall, 49% of women with untreated high titre syphilis experienced an adverse pregnancy outcome compared with 11% of uninfected women. Stillbirth and low birthweight rates among those treated for high- or low-titre syphilis were reduced to rates similar to those for uninfected women. The economic cost was $1.44 per woman screened and $10.56 per disability-adjusted life year saved. In the operational study, only 43% of 2256 ANC attenders observed were screened and only 61% of seroreactive women and 37% of their partners were treated. Adequate training, continuity of supplies, supervision and quality control are critical elements for strengthened antenatal services, but are frequently overlooked. CONCLUSIONS: Maternal syphilis has a severe impact on pregnancy outcome. Same-day screening and treatment strategies are clinically effective and highly cost-effective, but there are significant challenges to implementing syphilis screening programmes in sub-Saharan Africa. Current PMTCT interventions present an opportunity to reinforce and improve syphilis screening. Increasing PMTCT coverage will involve similar operational challenges to those faced by syphilis screening programmes.

Anti-Bacterial Agents↗

PubMed1994

Evaluation of a Treponema pallidum enzyme immunoassay as a screening test for syphilis.

The CAPTIA Syphilis-G enzyme immunoassay for the detection of antibodies to Treponema pallidum was evaluated as a screening test for syphilis in comparison with the standard rapid plasma reagin (RPR) test. One thousand samples were tested, and the standard fluorescent treponemal antibody absorption test and the standard microhemmaglutination test were used to confirm the presence of treponemal antibodies. Diagnosis of syphilis was based on traditional standard serology results. Clinical data used in the diagnosis of patients whose samples yielded conflicting results were provided by physicians. Initially, 7 patients whose samples were reactive in the RPR test and 14 patients whose samples yielded positive or equivocal results in the CAPTIA Syphilis-G test were diagnosed as not being infected. After discrepancies due to technical problems were reconciled, samples from six patients remained reactive in the RPR test and that from one patient remained positive in the CAPTIA Syphilis-G test. In addition, seven patients whose samples were nonreactive in the RPR test and two patients whose samples were negative in the CAPTIA Syphilis-G test were diagnosed as having untreated syphilis. After discrepancies were reconciled, samples from five patients remained nonreactive in the RPR test and none remained negative in the CAPTIA Syphilis-G test. Final results indicate that the specificities are 99.4 and 99.9%, respectively. In addition to the improved sensitivity and specificity of the CAPTIA Syphilis-G screen, other potential benefits of this assay lead us to believe that this method could serve as a better screening tool than the RPR test.

Evaluation Studies as Topic↗

PubMed2006

Management of a syphilis outbreak in street sex workers in east London.

OBJECTIVE: To describe the control and management of a syphilis outbreak in female street sex workers (SSWs) in east London. METHODS: Following the identification of several cases of infectious syphilis in SSWs in east London, a targeted service for screening and treatment of syphilis and other sexually transmitted infections was developed. A multidisciplinary team (MDT) joined an existing outreach service to facilitate this. Once it became apparent that this was not an isolated case, an outbreak control team (OCT) was established. RESULTS: Between April and December 2004 a total of 14 (58%) women with 15 cases of infectious syphilis were identified in 24 SSWs: 14/15 (93%) received treatment. Epidemiological treatment for syphilis was also given to the rest of SSWs at the initial visit. Several coexistent STIs were identified in this cohort. As part of the enhanced outbreak surveillance in north east London, 21 cases of infectious syphilis were reported in SSWs between April 2004 and December 2005. CONCLUSION: Outbreak management in this population was challenging: an MDT approach was crucial in identifying and treating syphilis to prevent onward transmission. There was a high prevalence of syphilis and other STIs in this cohort, and we treated the majority of cases. The formation of an OCT enabled us to monitor the outbreak and implement control measures more effectively. The novel intervention we describe has proved valuable in helping to control this syphilis outbreak.

Cohort Studies↗

PubMed1987

Effect of early and late syphilis on central nervous system: cerebrospinal fluid changes and neurological deficit.

Neurological examination and investigation of the cerebrospinal fluid (CSF) was performed on 24 patients with early and 180 patients with late syphilis. In 21 (12%) patients with late syphilis positive CSF treponemal test results and neurological deficits suggestive of symptomatic neurosyphilis were found. Concomitantly all but three patients with neurosyphilis showed one or more of the following abnormal CSF variables: CSF concentration of albumin X 10(3)/serum concentration (albumin ratio) greater than or equal to 7.9; mononuclear cells greater than 5 microliters: ratio of CSF to serum IgG concentrations/ratio of CSF to serum albumin concentrations (IgG index) greater than or equal to 0.7 or of IgM/albumin (IgM index) greater than or equal to 0.1; or oligoclonal CSF immunoglobulins. In 20 (95%) patients with neurosyphilis evidence of the production of treponemal antibodies within the central nervous system (CNS) was shown. Ten (48%) patients with neurosyphilis had been treated previously for late syphilis. These observations emphasise the need to screen for neurosyphilis in patients with late syphilis. Intrathecal production of treponemal antibodies was detected in six (25%) patients with early and 44 (28%) with late syphilis who did not show any neurological deficit. Intrathecal production of treponemal antibodies indicating that the CNS was affected led us to suspect asymptomatic neurosyphilis in these patients. Seventeen (11%) patients with late syphilis but no neurosyphilis and only one (4%) with early syphilis showed additional abnormal CSF variables. Surprisingly, six out of 22 patients with treated early and 20 out of 68 patients with treated late syphilis showed evidence of treponema antibody production within the CNS. We do not know whether these findings indicate that the CNS was affected because of inadequate treatment or merely reflect persistent synthesis of treponemal antibodies associated with cured infection. In one (4%) patient with early and in 21 (13%) with late syphilis but no neurosyphilis abnormal CSF variables in the absence of positive CSF treponemal test results were observed, which excluded syphilitic inflammation of the CNS.

Antibodies, Bacterial↗

PubMed1989

An IgM capture enzyme linked immunosorbent assay to detect IgM antibodies to treponemes in patients with syphilis.

A new IgM capture enzyme linked immunosorbent assay (ELISA) was compared with the 19S(IgM) fluorescent treponemal antibody absorption (19S(IgM)FTA-ABS) test for detecting IgM antibodies to treponemes. Serum samples from 180 people, 109 with various stages of untreated syphilis, 45 with treated syphilis, and 26 non-infected, were investigated. In all diagnostic groups of syphilis the reactivity of the IgM capture ELISA was similar to that of the 19S(IgM)FTA-ABS test except in untreated neurosyphilis, for which the IgM capture ELISA was significantly less sensitive. The IgM capture ELISA was very sensitive in congenital (100%, 5/5) and primary (82%, 18/22) syphilis, but less sensitive in secondary (60%, 12/20), latent (53%, 16/30), neurosyphilis (34%, 11/32), and treated (11%, 5/45) syphilis. False positive IgM capture ELISA results were not found in five people who gave false positive Venereal Disease Research Laboratory (VDRL) reactions or in 21 neonates born to mothers adequately treated for syphilis before or during pregnancy. This indicated that the IgM capture ELISA was very specific. The course of antitreponemal IgM reactivity after treatment of early infectious syphilis was followed up in six patients. The quantity of IgM antibody declined in nearly all patients after treatment, but still remained detectable in five patients up to six months after treatment. In contrast, non-treponemal antibodies measured by the VDRL test disappeared in four out of six patients within five months from starting treatment. In conclusion, the IgM capture ELISA may be useful for easy and sensitive detection of IgM antibodies to treponemes in patients with congenital and primary syphilis. A positive test result in these cases indicates that patients should receive treatment if they have not been treated recently. The test is not, however, recommended to replace the VDRL test to monitor patients treated for syphilis.

Antibodies, Bacterial↗

PubMed1999

Epidemiology of syphilis and gonorrhoea in eastern Poland in the years 1988-1997.

Because of the sexually transmitted diseases (STDs) epidemic in the former Soviet Union and the possibility of a rise in early syphilis and gonorrhoea in the eastern region of Poland it seemed important to calculate the incidence rates for early syphilis and gonorrhoea for 3 border regions (east, west and south) and the central part of the country in the last 10 years. In addition, data were analysed on patients and their sexual partners (from Poland and abroad), and the country where the contact took place obtained from 14 Provincial Skin-VD Out-Patients' Clinics of eastern Poland. The results from 1988/89 and 1996/97 were compared. It was shown that early syphilis morbidity significantly decreased in western and southern Poland, fell in the central part and rose in the east slightly. Gonorrhoea morbidity significantly decreased in all regions. However, the number of provinces with early syphilis and gonorrhoea incidence rates in the 1990s of the same value or higher than in the 1980s, or of the whole of Poland clearly increased in eastern and central regions. The early syphilis and gonorrhoea morbidity in east Poland in the 1990s in relation to 1980s was marked by significant increase in the percentage of the foreigners treated (12.2 vs 1.8, P<0.001 for early syphilis, and 10.0 vs 2.3, P<0.001 for gonorrhoea) and in sexual contacts with foreigners reported by Polish patients (23.7 vs 0.8, P<0.01 for early syphilis and 17.7 vs 4.3, P<0.01 for gonorrhoea). Of the foreign contacts reported in 1996/97 by early syphilis and gonorrhoea patients, 60.4% and 82.2%, respectively, were casual. Contact with foreigners took place, mainly, in the former Soviet Union. The study illustrates that there may be a danger of an increase in the incidence of syphilis and gonorrhoea in Poland due to the epidemics in the neighbouring countries.

Emigration and Immigration↗