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| EPI-NEWS |
National surveillance of communicable diseases
Dept. of Epidemiology
Editor: Susanne Samuelsson |
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| Tel.: +45 3268 3038 - Fax: +45 3268 3874 |
| epinews@ssi.dk - ISSN: 1396-4798 | |
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| SYPHILIS 2002 |
Laboratory-detected cases
There were 63 cases of syphilis detected in 2002, compared with 34, 54, and 51 in 1999, 2000 and 2001 respectively, EPI-NEWS 34/00 and 26-33/02. The number has thus almost doubled since 1999. The figures include both early (duration <2 years) and late cases, table 1. Congenital syphilis could not be ruled out in one patient, an immigrant from Africa.
Acquired syphilis
Cases of acquired syphilis were detected in almost all Danish counties and, as previously, by far the highest frequency (47%) was in Copenhagen Municipality, table 2.
A total of 19% of the cases were detected in general practice, 49% in public STI clinics and 29% in hospital wards, table 3.
Over the last few years, fewer cases have been diagnosed in general practice and more in public STI clinics. The proportion of Danish-born persons with syphilis is increasing.
In 2002, a total of 57% of men and 46% of women with syphilis were Danish-born, table 4.
Other patients, in order of frequency, were from: Asia, Africa, Europe and North, Central and South America. Country of infection was not stated for 41% of patients, table 5.
Like in 2000 and 2001, syphilis was acquired within Denmark in 2002. Acquisition from abroad was, in order of frequency from: Europe, Africa, Asia and North America.
The patients' age distribution is shown in table 6. Most of the men were aged 25-39. In 2002 one pregnant woman was detected with syphilis, compared to six in 2000.
Notified cases
In 2002, 34 cases of syphilis were notified, 31 men and three women, corresponding to a notification rate of 54% of diagnosed cases. Of the 31 men, 24 were Danish-born and seven were immigrants. In all, 24 of the men (77%) were homosexual, of whom 20 were Danish-born and four were immigrants, table 7. By comparison, in 2000, homosexual men made up 33% of all notified cases of men with syphilis. For men, the median age was 32 (range: 20-53). The three women, two of whom were immigrants and one Danish-born, were aged 17, 18 and 20 years. Two were infected by their stable partners in Denmark, and one was infected in Estonia. Her source of infection was not stated. A total of eight patients (24%), all men, were also HIV positive: five were homosexual and three heterosexual. The five homosexual men had each been infected in Denmark by casual contact. For one of these, it was impossible to trace the source of infection. Of the three HIV-infected heterosexual men, one was infected in Thailand and one in North Africa, and the country of infection of the third was not stated. One had been infected by a sex worker. In the two other cases the source of infection was not stated. It was stated that the source of infection could not be traced for five patients, of whom four were HIV positive.
Comments
The number of cases of syphilis has again increased in 2003 to date, especially among homosexual men. The vast majority of sources of infection for homosexual men were, as previously, casual contacts; a trend that has also been seen in other countries. The number of detected cases of syphilis in women has been low since 1999. Noticeably, only one pregnant woman was diagnosed with syphilis in 2002, compared to 11 in 1998, when selective screening of pregnant women was introduced instead of the previous general screening. Accordingly, far fewer pregnant women are now examined. This suggests that undetected intrauterine infection may be occurring, as congenital syphilis is a difficult diagnosis for physicians to make unless there is a previous indication . So far, in 2003, two children born of Danish-born mothers are being investigated for suspected congenital syphilis.
(N. Axelsen. Dept. of Clinical Biochemistry, G. H. Kock-Hansen, E. Smith, Dept. of Epidemiology)
10 September 2003
ALSO IN THIS ISSUE:
Update: Streptococci isolated from blood and CSF from infected patients
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