Background In Germany, the number of syphilis cases doubled 2001–04 to over 3,000/year and remained mainly stable until 2009. Between 2010 and 2013, the number increased between 11% and 22%. We analysed syphilis surveillance data to assess characteristics of this rise and whether it is continuing.
Methods Since 2001, laboratories are required to notify syphilis diagnoses anonymously, physicians complement clinical information. Potential double notifications are identified. We described syphilis cases by year of diagnosis, age, sex, area of residence and transmission category.
Results Overall, 5,722 cases were reported in 2014, corresponding to a 14% rise compared to 2013. The overall incidence was 7.1 per 100,000 inhabitants, with highest incidences in large cities such Berlin (31.0), Cologne (31.9) and Munich (27.2), especially in Berlin inner city areas (61.3–86.2/100,000 inhabitants). Notified cases increased in 13/16 federal states in 2014, and increase in Germany in a linear manner by 669 cases/year since 2010 (R2 = 0.9994).
Men accounted for 94% of cases in 2014. The likely mode of transmission was available for 74% of cases; of these, 84% were men who have sex with men (MSM), in 16% heterosexual transmission was reported. The proportion of MSM aged 40 years or above was stable since 2008 with 49%. Stage of infection was reported in 74% of cases in 2014. Of these, 35% were diagnosed as primary, 27% as secondary and 35% as latent syphilis, similar to previous years.
Conclusion Syphilis cases continue to increase strongly since 2010, mainly attributable to MSM in large German cities, also in higher age groups. Berlin as a centre of sex tourism for MSM worldwide is heavily affected. Against the background of high proportions of cases diagnosed in later stages, early diagnosis and treatment, but also consistent condom use, are important to minimise the risk of syphilis and subsequently potential HIV-transmission.
Disclosure of interest statement The authors have nothing to disclose.