Venereal syphilis in tropical Africa.

Abstract

SUMMARY A steady decline in the incidence of positive results to the Kahn test is reported in Malawian patients during the period 1968-75. Other studies have shown that the incidence of early and late syphilis in sub-Saharan Africa has dropped considerably over the past few decades. The number of reported cases of early syphilis in certain urban areas, however, appears to be high. It is suggested that the downward trend in the incidence of syphilis in Africa is related to the increased and often indiscriminate use of penicillin. IntroductionAnnual statistics have shown an apparent increase in the incidence of infectious syphilis in most western countries since about 1955. This increase is sometimes referred to as being 'world-wide', thus indicating that the same trend has also been observed in Africa. Although reliable information on the prevalence of venereal syphilis in African countries is scarce, it is a common assumption that syphilis is highly prevalent in most developing countries (Harris, 1975). The apparent increase in the incidence of infectious syphilis in Africa is attributed to changing environmental patterns, principally accelerated urbanisation and general migration. Moreover, the successful eradication of yaws in the 1950s is said to have made whole populations susceptible to infection with Treponema pallidum.During a three-year stay in Malawi, I noticed that the number of patients with early syphilis seen at the skin clinics in Blantyre was surprisingly low. Only 21 cases were registered over three years, whereas 1200-1600 new dermatological cases were seen each year. A study was (Trowell, 1960).In East Africa several authors had analogous findings. Beecher (1960) analysed the inpatient statistics of Kiambu Hospital, Kenya, from 1939-58. Whereas the number of cases of early syphilis ranged from 1-5 to 10-9 per 1000 admissions during the first half of the period under review, none was recorded in 1958. Reports from Kampala, Uganda, also show that the number of positive cases, using comparable test procedures, decreased considerably between 1966 and 1970 (Foster and Kerchan, 1966;Massawe, 1970). In West Africa Ba et al (1965) studied the epidemiological aspects of syphilis serology of outpatients in Dakar, Senegal, over the period 1956-64; the percentage of positive results showed a steady decline. These observations agree with recent reports from other African countries, indicating a low incidence of positive serological results in patients at prenatal consultations (Osoba and Onifade, 1973;Meheus et al, 1975).In contrast, a very high incidence of syphilis has been reported from a few, predominantly urban, areas. In Kampala venereal diseases, in-364 on 12 May 2018 by guest. Protected by copyright.

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“…The World Health Organization labels Ethiopia with the highest age-standardized disability-adjusted life year rates for syphilis [3]. The incidence was decreasing prior to the HIV epidemic due to widespread indiscriminate use of penicillin [4]. There is now a global re-emergence of primary and secondary syphilis disproportionately affecting patients with HIV [5].…”