The Global Epidemiology of Syphilis in the Past Century – A Systematic Review Based on Antenatal Syphilis Prevalence

Abstract

BackgroundHow can we explain the uneven decline of syphilis around the world following the introduction of penicillin? In this paper we use antenatal syphilis prevalence (ASP) to investigate how syphilis prevalence varied worldwide in the past century, and what risk factors correlate with this variance.Methods1) A systematic review using PubMed and Google Scholar was conducted to identify countries with published data relating to ASP estimates from before 1952 until the present. Eleven countries were identified (Canada, Denmark, Finland, India, Japan, Norway, Singapore, South Africa, United States of America (USA), United Kingdom (UK) and Zimbabwe). The ASP epidemic curve for each population was depicted graphically. In South Africa and the USA, results are reported separately for the black and white populations. 2) National antenatal syphilis prevalence estimates for 1990 to 1999 and 2008 were taken from an Institute for Health Metrics and Evaluation database on the prevalence of syphilis in low risk populations compiled for the Global Burden of Diseases study and from a recent review paper respectively. National ASPs were depicted graphically and regional median ASPs were calculated for both time periods. 3) Linear regression was used to test for an association between ASP in 1990–1999 and 2008 and four risk factors (efficacy of syphilis screening/treatment, health expenditure, GDP per capita and circumcision prevalence). WHO world regions were included as potential explanatory variables.ResultsIn most populations, ASP dropped to under 1% before 1960. In Zimbabwe and black South Africans, ASP was high in the pre-penicillin period, dropped in the post-penicillin period, but then plateaued at around 6% until the end of the 20th century when ASP dropped to just above 1%. In black Americans, ASP declined in the post penicillin period, but plateaued at 3–5% thereafter. ASP was statistically significantly higher in sub-Saharan Africa in 1990–1999 and 2008 than in the other world regions (P < 0.001). On multivariate analysis in both time periods, ASP was only associated with residence in sub-Saharan Africa.ConclusionsFurther research is necessary to elucidate the reasons for the higher prevalence of syphilis in sub-Saharan Africa.

Screening for Syphilis in Cases of Suspected Gonorrhea and Chlamydia Infections

“…In Zimbabwe and black South Africans, ASP was high in the pre-penicillin period, dropped in the post-penicillin period, but then plateaued at around 6% until the end of the 20th century. 9 Ballah and colleagues indicated that strengthening current surveillance systems for syphilis is important to track and monitor disease burden. Usage of routinely collected laboratory information to generate surveillance was proposed in South Africa; annually for the period from 2003 to 2012 there was an approximate 14% reduction of syphilis seroprevalence.…”

Gene subtype analysis of Treponema�pallidum for drug resistance to azithromycin

“…Currently, the incidence of syphilis is increasing in multiple developed countries (6,7). Although various treatments have been explored, including antibiotic therapy and antiviral therapy, these regimens are unsatisfactory, particularly in specific populations (8,9). Therefore, early diagnosis and effective treatment of patients at the early stage of syphilis are essential for inhibition of T. pallidum infection.…”

Prevalence Of Syphilis, Neurosyphilis And Associated Factors In a Cross-Sectional Analysis Of HIV Infected Patients Attending Bugando Medical Centre Mwanza Tanzania

“…In studies in Mwanza, syphilis affects ~8% of healthy outpatients, and older studies have suggested that up to 23.5% of HIV-syphilis co-infected patients also have neurosyphilis Background In spite of effective preventive and treatment options syphilis is still a global health problem causing high morbidity. It is estimated that about 10 million people worldwide are infected each year with a global prevalence of about 0.5% (1).In sub Saharan Africa the burden has dropped from 6% to around 1% in the past 50 years (1,2).In Tanzania the prevalence of syphilis ranges from 2.5% to 8% in antenatal clinics and community surveys, respectively (3,4) .In sub Saharan Africa heterosexuals are most highly affected (5).…”