Introduction

Syphilis has often been a problem of great concern in many countries and not only because if untreated the disease may affect any organ, but it can also be inherited—that is, children are born with congenital syphilis.^1–6 After the second world war the highest indices in Latvia were recorded in 1973 (82.6 cases per 100 000 people). With strict preventive measures the situation from 1980 to 1990 was comparatively good—5–10 cases per 100 000 inhabitants but since 1993 a dramatic increase in the incidence of syphilis has been noted again.

Methods

Syphilis was diagnosed by finding Treponema pallidum or by serological and immunofluorescence reactions (RPR, VDRL, TPHA, IFR abs IgM, IFA), gonorrhoea by finding gonococci and diagnosing by Gen-Probe Pace 2 and polymerase chain reaction.

Results

As seen in table 1, 1996 had the highest syphilis morbidity level over the previous 10 years; in Latvia there were 3124 cases and in Lithuania 3761, but in Estonia the highest level was in 1998, 1101.

Most alarming is the fact that the incidence of syphilis in Latvia is increasing among young people. In 1996, there were 10 cases in those aged 13–14 years and 184 cases in the age group 15–17 years; seven children acquired the disease from parents; and 25 cases were congenital. In 1998 the figure were five, 119; and seven; and 15, respectively.

The highest morbidity level of gonorrhoea over the past decade was in 1993 with 4223 cases in Latvia, 5626 cases in Lithuania, and 3535 in Estonia, and it is currently still high.

Discussion

In eastern Europe the incidence of syphilis in 1996 was the following: in Russia 263 cases, Kazakhstan 231, Moldavia 200, Belorus 210, Latvia 125, Estonia 66, Lithuania 101, and morbidity was dramatically increasing.⁴

In the United States in the early 1990s this was connected with the high level of drug addiction—”crack” cocaine use.¹ This is partly the situation in Latvia, as well as in the other eastern European countries where the prostitution level is also very high.⁵

Fluctuations in syphilis morbidity are parallel to changes in the political situation, increased migration of people, expanded import, and dissemination of pornographic information in the country. Since 1993, the rise in syphilis morbidity has been due to prostitution, publicised but medically uncontrolled, and to the rapid rise in the level of unemployment, alcohol abuse, drug addiction Advertising of prostitution is spreading. In Latvia more that 200 clubs offering services by prostitutes have sprung up although prostitution has not been legalised.⁵

Pornographic and sex literature are brought into Latvia and are widely available, lowering the morals and ethics of the population, particularly of teenagers. The same situation also exists in the neighbouring countries.^{4, 5}

Conclusions

In the years 1993–8 the number of cases of syphilis and gonorrhoea in Latvia, Lithuania, and Estonia was very high. A special national strategy programme to prevent further increase of syphilis, gonorrhoea, and other STDs should be developed.