Background The number of reported syphilis cases in Germany doubled between 2001–2004 to over 3,000/year and remained stable until 2009. Between 2010 and 2016, the annual increase was between 7% and 22%. We analysed syphilis surveillance data to assess characteristics of current epidemiological dynamics in order to initiate appropriate prevention measures.

Methods Since 2001, laboratories are required to notify syphilis diagnoses anonymously, physicians complement clinical information. Potential double notifications are identified. Since 2016, HIV-status is reported. We analysed syphilis cases by year of diagnosis, age, sex, area of residence, and transmission category.

Results 7,520 cases were reported in 2017, corresponding to a 4.5% rise compared to 2016. Incidence was 9.1/100,000 inhabitants, with highest incidences in metropolitan cities as Cologne (39.4), Berlin (37.9), and Munich (35.0). From January to June 2018, syphilis cases dropped by 4.3% compared to this period in 2017. Men accounted for 94% of cases in 2017. 83% of cases with information on transmission route were men who have sex with men (MSM), 17% heterosexuals. The proportion of MSM aged 40 years or above was continuously above 45% since 2007. Syphilis reinfection was reported for 27% HIV-negative MSM and 63% HIV-positive MSM. HIV-coinfection was reported for 48% MSM and 7% heterosexuals. HCV-coinfection was reported for 7% HIV-positive MSM and 1% of HIV-negative MSM.

Conclusion Data showed a high burden of disease in MSM in metropolitan cities and higher age groups. Increasing risk behavior due to HIV pre-exposure prophylaxis (PrEP) could impact the syphilis epidemic in Germany in specific groups, considering the high proportion of Syphilis reinfections as well as a distinct rate of HCV-coinfection. To avoid negative effects of PrEP for the Syphilis epidemic, targeted and innovative approaches to foster early screening and treatment, like internet counselling, home sampling, home testing and broadening venue-based (rapid) testing should be discussed.

Disclosure No significant relationships.