Introduction

Syphilis is a complex community disease, with multiple stages and unique presentations involving almost every organ system, and which can be controlled by public health measures.

The aim of this study was analyse and report on the syphilis case finding programme as implemented through the dermatology clinic of Athens University.

Method

The syphilis screening and treatment programme took place between 09.00 to 12.00 on six days between 1 January 1974 and 31 December 1998. Primary, secondary, and early latent syphilis (referred to collectively as early syphilis) were defined using generally accepted criteria.¹ People were recruited for screening in “A Syngros” Hospital, Athens, then taken to the same hospital for further investigation and treatment. The principal screening tests for syphilis were the Venereal Disease Research Laboratory (VDRL) test and the rapid plasma reagin (RPR) test.² All positive cases were confirmed by treponema test TPHA or FTA.

Results

Table 1 shows the prevalence of detected syphilis cases for each year between 1974 and 1998 in both men and women. For men, all age strata remained stable from 1974 to 1991 followed by a sharp drop, the minimum occurring in 1996. In contrast, the positive women were on average younger than men. Moreover, in 1991 and thereafter no differences were observed in age between male and female patients.

The number of patients with the primary stage of the disease was almost equal to the number of patients with the secondary stage of syphilis, whereas the other classified forms comprised only one seventh of the positive cases. Moreover, a high percentage of asymptomatic men (21.8%) and women (32.8%) was observed among the syphilis patients.

Discussion

During the past 25 years, it is estimated that affected men visited our department much more often because their symptoms were obvious and severe, whereas the observed small number of female patients could be the result of a self treatment, or for other reasons such as their occupation, fear of a social stigma, and/or a general unwillingness to be examined by a doctor.³

Additionally, the observed continuing decline of the incidence of the disease could be for the following reasons: (a) the better standard of living, (b) the use of a condom as a preventive measure against AIDS,⁴ (c) the higher education level, and/or (d) the opportunity of admission in a private venereal disease clinic.

Furthermore, the median age of the syphilis cases for both sexes showed a continuing decline which was discontinued during the years 1980–3 when an “immigration wave” from eastern Europe, especially from Russia, moved in Greece.⁵

The high percentage of early latent cases (which were asymptomatic) among the patients suggested that preventive measures reduced transmission, since asymptomatic men accounted for a disproportionate share of STD transmission⁶ and were unlikely to seek medical attention on their own.

Consideration should be given to using screening for long periods, repeating the programme in the same population at intervals to determine if a change in incidence occurs.