Elsevier

The Lancet

Volume 350, Issue 9072, 19 July 1997, Pages 210-213
The Lancet

Public Health
Epidemics of syphilis in the Russian Federation: trends, origins, and priorities for control

https://doi.org/10.1016/S0140-6736(97)01382-2Get rights and content

Summary

After continuous decline throughout the 1980s, surveillance-defined estimates of the incidence of syphilis in Russia have shown a rapid and substantial increase during the 1990s. The reasons for this epidemic are unclear, but must be sought among changes both in sexual behaviour and in the patterns of provision, use, and effectiveness of diagnostic, treatment, and contact tracing services. High incidence of sexually transmitted disease causes correspondingly high levels of morbidity and suffering as well as significant health-care and other economic costs. Our current understanding suggests that the transmissibility of HIV is increased by infection with sexually transmitted disease. The syphilis epidemic together with changes in sexual behaviour, increased travel and migration, and rapid increases in injecting drug use may create the conditions for an epidemic of sexually acquired HIV infection in Russia that substantially outstrips those encountered in most Western European countries.

Section snippets

Control and surveillance of syphilis and other sexually transmitted infections

A highly developed state system for the control and surveillance of syphilis and other sexually transmitted infections has existed in the Russian Federation since World War II.6 It is centred around a clinical Dermatovenereology Service, and an associated network of dermatovenereology research institutes. The Service provides free diagnosis, treatment, and partner notification, and manages an extensive programme of active compulsory case-finding and screening in clinical and occupational groups.

Trends in syphilis notifications

The data we present in this section are drawn from records of notified newly identified cases of syphilis held by the Ministry of Health of the Russian Federation. Absolute numbers of cases notified in different years are presented, or rates per 100 000 calculated from population estimates published by the National Statistical Committee for the relevant years.

Annual notification rates for syphilis between 1945 and 1996 (where available) for the Russian Federation are presented in the Figure 1.

Trends in prevalence of syphilis by occupation in the Moscow Region

The security with which trends in the occurrence of an infection may be inferred from trends in case notification rates is always compromised by uncertainty as to whether the completeness of case ascertainment and notification have changed with time. Data from serial seroprevalence surveys can provide useful information because case ascertainment does not depend on clinical presentation, and the number of individuals tested is known. Such data are available from the programme for the active

Origins of the trends

Could the remarkable trends in national notification rates be artefacts arising from changes in the completeness of case ascertainment or notification? The confidential service provided by the clinics that allow the patients to remain anonymous and decreased use of legal sanctions may have encouraged self-presentation to services. The slight increase in the proportion of notified cases of syphilis diagnosed through self-presentation is consistent with this theory, but is too small to explain

Implications of epidemics and priorities for control

A major epidemic of syphilis is occurring in Russia and there are good reasons to seek its origins in the multiple effects of political, economic, and ideological changes on sexual behaviour and the effectiveness of clinical services. The epidemic in Russia is causing significant human suffering through acute infection and through the sequelae of longer-term infection. Similar epidemics are occurring in other countries on the eastern side of Europe.20 Countries of western Europe are already

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