A resurgence of syphilis in high-income countries after low incidence for the past two decades means retraining of doctors is necessary, according to new research.
A review in the April edition of The Lancet Infectious Diseases says many doctors are now unfamiliar with the many manifestations of the disease.
The resurgence of syphilis in the 21st century after 20 years of low incidence means that there is a need for renewed vigilance among, and training of, doctors and health-care professionals, says the review by the authors.
Dr Kevin Fenton of the Centers for Disease Control and Prevention in Atlanta, USA, and colleagues say: “In many high-income countries, successes in syphilis prevention and control were accelerated during the early and mid-1990s, with many countries approaching or achieving elimination of endemic disease transmission.
“However, since the beginning of the 21st century, syphilis incidence has started to rise in high-income settings, in part driven by increases in cases among men who have sex with men, although more recent increases among heterosexual people have also been reported.”
Syphilis infects around 12 million people worldwide every year and although it is particularly problematic in developing countries, the review focuses on the alarming recent trends in high-income countries.
Since 1996, syphilis has been on the increase in many northern and western EU countries.
Belgium reported a 3.5 fold increase in syphilis cases between 2000 and 2002, while cases in Austria steadily increased from a low point of 124 in 1993 to 420 in 2002.
The authors say: “Other major urban centres such as London, Dublin, Berlin, Paris, and Rotterdam all showed huge increases in syphilis reports during this period, predominantly among populations of men who have sex with men.
“Increases in the UK were initially observed in larger cities, then progressed to suburban and rural settings.”
They conclude: “In developed countries, the low incidence of syphilis over the past two decades and the interactions of the disease with HIV infection have resulted in clinicians who are unfamiliar with the disease’s many manifestations. The recent resurgence among men who have sex with men and some high-risk heterosexual couples raises cause for concern, and demands renewed vigilance among, and training of, health-care professionals.”
Lancet Infect Dis 2008; 8: 244-53