E. HiltunenBack1, O. Haikala1,
P. Koskela1, Timo Reunala2
1 National Public
Health Institute, 2 Helsinki University, Department of Dermatology,
In the early 1990s only 30 to 40 new serologically
confirmed cases of syphilis were reported annually in Finland. Typical
syphilis patients were heterosexual men who acquired the infection abroad.
Since 1993, the incidence of syphilis has increased (see figure). In 1995,
a total of 118 new cases were diagnosed, which is nearly twice as many
as in 1994 (63 cases). Thirty-seven per cent of all patients diagnosed
with syphilis in 1995 were female, 77% of whom had been infected in Finland.
Sixty-five per cent of males diagnosed in 1995 were infected abroad, 51%
in Russia (1). Most of the cases in 1995 were found in southern Finland
or in the south east near the Russian border (2). One cluster of 30 cases
was discovered in the central part of Finland, in the city of Tampere.
The origins of this local outbreak were three males, who acquired the
infection in Russia.
Travel to St Petersburg and to neighbouring areas
for business and for pleasure has increased remarkably since the Soviet
Union collapsed. In 1995, the incidence of syphilis in Russia was 86 times
higher (172/100 000) than in Finland (2/100 000) and is increasing (twofold
during 199495). In 1995, 255 000 cases of syphilis were reported
in the Russian Federation. In St Petersburg the incidence of syphilis
(318/100 000; 15 000 reported cases) is among the highest in Russian administrative
Women have been screened for syphilis infection in
early pregnancy in Finland for 50 years. No congenital cases of syphilis
have been reported since 1981. From 1991 to 1995, serum specimens from
332 400 pregnant women were tested. Positive results with nontreponemal
antigens (RPR) were detected in specimens from 839 women; 73 of these
specimens were also positive in the treponemal antigen test (treponemal
haemagglutination). Old, treated syphilis infection was the cause of positivity
in 54 cases. Undiagnosed, early (primary/secondary) syphilis was detected
in the remaining 19 patients. In 1995, six early cases of syphilis were
identified among pregnant women. Two women were Finnish, three Russian,
and one was from Thailand (3).
This report stresses the need for timely surveillance
of syphilis in order to target clinical and prevention services to people
exposed to the risk of transmission.
1. National Public Health Institute, Helsinki, Finland:
1995 Official statistics (unpublished)
2. State Committee for Sanitary and Epidemiological
Surveillance. Infectious Disease Statistics of the Russian Federation.
Moscow, Russia: 1996.
3. Koskela P. Syphilis screening in pregnant women. Kansanterveys
1996; (4):23. Finland