Surveillance and outbreak report Open Access
Like 0


In Germany, the number of reported syphilis cases increased between 11% and 22% per year between 2010 and 2014. We analysed syphilis surveillance data and data of four behavioural surveys on men who have sex with men (MSM) in Germany (2003, 2007, 2010, 2013) to assess if this rise is ongoing and to find possible explanations for it. Syphilis notifications increased in 2015 by 19% to a total of 6,834. This was mainly due to increasing notifications in MSM of all age groups in larger German cities. Data from the behavioural surveys on MSM in Germany showed a simultaneous increase of selective condom use as HIV-status-bases risk management strategy and the number of syphilis cases. MSM diagnosed with HIV reported condomless anal intercourse with non-steady partners more frequent than MSM not diagnosed with HIV or untested for HIV, but the latter also reported higher frequencies of this behaviour in the more recent surveys. Transmission in HIV-positive MSM probably plays an important, but not exclusive role, for the syphilis dynamics in Germany. A risk adapted routine screening for sexually active MSM and potentially innovative approaches to increase early screening and treatment of syphilis such as internet counselling, home sampling, home testing and broadening venue-based (rapid) testing, should be critically evaluated to effectively reduce syphilis infections.


Article metrics loading...

Loading full text...

Full text loading...



  1. Centers for Disease Control and Prevention (CDC). Sexually Transmitted Disease Surveillance. Atlanta: U.S. Department of Health and Human Services; 2015. Available from: https://www.cdc.gov/std/stats14/surv-2014-print.pdf
  2. Chen G, Cao Y, Yao Y, Li M, Tang W, Li J, et al. Syphilis incidence among men who have sex with men in China: results from a meta-analysis. Int J STD AIDS. 2016. PMID: 26992411 
  3. European Centre for Disease Prevention and Control (ECDC). Sexually transmitted infections in Europe - 2013. Stockholm: ECDC; 2015. Available from: http://ecdc.europa.eu/en/publications/publications/sexual-transmitted-infections-europe-surveillance-report-2013.pdf
  4. The Kirby Institute. HIV, viral hepatitis and sexually transmissible infections in Australia. Sydney: The Kirby institute; 2015. Available from: https://kirby.unsw.edu.au/sites/default/files/hiv/resources/ASR2015.pdf
  5. Robert Koch-Institute. Weiterer starker Anstieg der Syphilis bei MSM in Deutschland im Jahr 2014. [Ongoing strong increase of syphilis in MSM in Germany in 2014]. Epidemiologisches Bulletin. 2015, 49: 515-528. German. Available from: https://www.rki.de/DE/Content/Infekt/EpidBull/Archiv/2015/Ausgaben/49_15.pdf?__blob=publicationFile
  6. Burchell AN, Allen VG, Gardner SL, Moravan V, Tan DH, Grewal R, et al. OHTN Cohort Study Team. High incidence of diagnosis with syphilis co-infection among men who have sex with men in an HIV cohort in Ontario, Canada. BMC Infect Dis. 2015;15(1):356.  https://doi.org/10.1186/s12879-015-1098-2  PMID: 26289937 
  7. Jansen K, Thamm M, Bock CT, Scheufele R, Kücherer C, Muenstermann D, et al. HIV Seroconverter Study Group. High Prevalence and High Incidence of Coinfection with Hepatitis B, Hepatitis C, and Syphilis and Low Rate of Effective Vaccination against Hepatitis B in HIV-Positive Men Who Have Sex with Men with Known Date of HIV Seroconversion in Germany. PLoS One. 2015;10(11):e0142515.  https://doi.org/10.1371/journal.pone.0142515  PMID: 26555244 
  8. Jin F, Prestage GP, Zablotska I, Rawstorne P, Imrie J, Kippax SC, et al. High incidence of syphilis in HIV-positive homosexual men: data from two community-based cohort studies. Sex Health. 2009;6(4):281-4.  https://doi.org/10.1071/SH09060  PMID: 19917195 
  9. Malek R, Mitchell H, Furegato M, Simms I, Mohammed H, Nardone A, et al. Contribution of transmission in HIV-positive men who have sex with men to evolving epidemics of sexually transmitted infections in England: an analysis using multiple data sources, 2009-2013. Euro Surveill. 2015;20(15):21093.  https://doi.org/10.2807/1560-7917.ES2015.20.15.21093  PMID: 25953130 
  10. Martí-Pastor M, García de Olalla P, Barberá MJ, Manzardo C, Ocaña I, Knobel H, et al. HIV Surveillance Group. Epidemiology of infections by HIV, Syphilis, Gonorrhea and Lymphogranuloma Venereum in Barcelona City: a population-based incidence study. BMC Public Health. 2015;15(1):1015.  https://doi.org/10.1186/s12889-015-2344-7  PMID: 26438040 
  11. Hotton AL, Gratzer B, Mehta SD. Association between serosorting and bacterial sexually transmitted infection among HIV-negative men who have sex with men at an urban lesbian, gay, bisexual, and transgender health center. Sex Transm Dis. 2012;39(12):959-64.  https://doi.org/10.1097/OLQ.0b013e31826e870d  PMID: 23191950 
  12. Kennedy CE, Bernard LJ, Muessig KE, Konda KA, Akl EA, Lo YR, et al. Serosorting and HIV/STI Infection among HIV-Negative MSM and Transgender People: A Systematic Review and Meta-Analysis to Inform WHO Guidelines. J Sex Transm Dis. 2013;2013:583627.
  13. Khosropour CM, Dombrowski JC, Swanson F, Kerani RP, Katz DA, Barbee LA, et al. Trends in serosorting and the association with HIV/STI risk over time among men who have sex with men (MSM). J Acquir Immune Defic Syndr. 2016;72(2):189-97.  https://doi.org/10.1097/QAI.0000000000000947  PMID: 26885806 
  14. Lociciro S, Jeannin A, Dubois-Arber F. Men having sex with men serosorting with casual partners: who, how much, and what risk factors in Switzerland, 2007-2009. BMC Public Health. 2013;13(1):839.  https://doi.org/10.1186/1471-2458-13-839  PMID: 24025364 
  15. Marcus U, Schmidt AJ, Hamouda O. HIV serosorting among HIV-positive men who have sex with men is associated with increased self-reported incidence of bacterial sexually transmissible infections. Sex Health. 2011;8(2):184-93.  https://doi.org/10.1071/SH10053  PMID: 21592432 
  16. Snowden JM, Wei C, McFarland W, Raymond HF. Prevalence, correlates and trends in seroadaptive behaviours among men who have sex with men from serial cross-sectional surveillance in San Francisco, 2004-2011. Sex Transm Infect. 2014;90(6):498-504.  https://doi.org/10.1136/sextrans-2013-051368  PMID: 24687128 
  17. Janier M, Hegyi V, Dupin N, Unemo M, Tiplica GS, Potočnik M, et al. 2014 European guideline on the management of syphilis. J Eur Acad Dermatol Venereol. 2014;28(12):1581-93.  https://doi.org/10.1111/jdv.12734  PMID: 25348878 
  18. Zeltser R, Kurban AK. Syphilis. Clin Dermatol. 2004;22(6):461-8.  https://doi.org/10.1016/j.clindermatol.2004.07.009  PMID: 15596316 
  19. Höhl N. Infektionsschutzgesetz (IfSG). [Protection against Infection Act]. Siegburg: Verlag W. Reckinger, 2013. German.
  20. Bochow M, Lenuweit S, Sekuler T, Schmidt AJ. EMIS 2010: Schwule Männer und HIV/AIDS: Lebensstile, Sex, Schutz- und Risikoverhalten - national report Germany. [EMIS 2010: Gay men and HIV/AIDS: life styles, sex, protection and risk behaviour – national report for Germany]. Berlin: 2012. German. Available from: http://www.emis-project.eu/sites/default/files/public/publications/emis_nationalreport_germany.pdf
  21. Bochow M, Schmidt A, Grote S. Schwule Männer und HIV/AIDS: Lebensstile, Szene, Sex 2007. [Gay men and HIV/AIDS: life styles, scenes, sex, 2007]. Berlin 2010. German.
  22. Bochow M, Wright M, Lange M. Schwule Männer und Aids: Risikomanagement in Zeiten der sozialen Normalisierung einer Infektionskrankheit. Eine Befragung im Auftrag der Bundeszentrale für gesundheitliche Aufklärung, Köln. [Gay men and AIDS: risk management in the times of social normalisation of an infectious disease. A survey on behalf of the Federal Agency for Health Education]. AIDS-Forum. 2004;Band 48:190 S. German.
  23. Drewes J, Kruspe M. Schwule Männer und HIV/AIDS 2013: Schutz- und Risikoverhalten in Zeiten der Behandelbarkeit von HIV. [Gay men and HIV/AIDS 2013: protection and risk behaviour in the times of treatability of HIV]. Berlin 2016. German. Available from: https://www.aidshilfe.de/system/files_force/documents/2016_05_11_schwule_maenner_und_hiv_aids_2013.pdf?download=1
  24. Marcus U, Schmidt AJ, Hamouda O, Bochow M. Estimating the regional distribution of men who have sex with men (MSM) based on Internet surveys. BMC Public Health. 2009;9(1):180.  https://doi.org/10.1186/1471-2458-9-180  PMID: 19519888 
  25. Marcus U, Schmidt AJ, Kollan C, Hamouda O. The denominator problem: estimating MSM-specific incidence of sexually transmitted infections and prevalence of HIV using population sizes of MSM derived from Internet surveys. BMC Public Health. 2009;9(1):181.  https://doi.org/10.1186/1471-2458-9-181  PMID: 19519889 
  26. European Centre for Disease Prevention and Control (ECDC). EMIS 2010: The European Men-Who-Have-Sex-With-Men Internet Survey. Findings from 38 countries. Stockholm: ECDC. 2013. Available from: http://ecdc.europa.eu/en/publications/Publications/EMIS-2010-european-men-who-have-sex-with-men-survey.pdf
  27. Paz-Bailey G, Mendoza MC, Finlayson T, Wejnert C, Le B, Rose C, et al. NHBS Study Group. Trends in condom use among MSM in the United States: the role of antiretroviral therapy and seroadaptive strategies. AIDS. 2016;30(12):1985-90.  https://doi.org/10.1097/QAD.0000000000001139  PMID: 27149088 
  28. Robert Koch-Institut. HIV-Diagnosen und AIDS-Erkrankungen in Deutschland. Bericht zur Entwicklung im Jahr 2014 aus dem Robert Koch-Institut [HIV diagnoses and cases of AIDS in Germany. Report on the situation in 2014 by the Robert Koch Institute. Epidemiologisches Bulletin.2015;2015(27):239-59.
  29. Marcus U, Hickson F, Weatherburn P, Schmidt AJEMIS Network. Estimating the size of the MSM populations for 38 European countries by calculating the survey-surveillance discrepancies (SSD) between self-reported new HIV diagnoses from the European MSM internet survey (EMIS) and surveillance-reported HIV diagnoses among MSM in 2009. BMC Public Health. 2013;13(1):919.  https://doi.org/10.1186/1471-2458-13-919  PMID: 24088198 
  30. European Centre for Disease Prevention and Control (ECDC). Understanding the impact of smartphone applications on STI/HIV prevention among men who have sex with men in the EU/EEA. Stockholm: ECDC; 2015. Available from: http://ecdc.europa.eu/en/publications/publications/impact-smartphone-applications-sti-hiv-prevention-among-men-who-have-sex-with-men.pdf
  31. Schmidt AJ, Hickson F, Weatherburn P, Marcus UEMIS Network. Comparison of the performance of STI screening services for gay and bisexual men across 40 European cities: results from the European MSM Internet Survey. Sex Transm Infect. 2013;89(7):575-82.  https://doi.org/10.1136/sextrans-2012-050973  PMID: 23744961 
  32. Schmidt AJ, Marcus U. [Deficits in STI diagnosis for men who have sex with men (MSM) in German-speaking cities: results of the European MSM Internet Survey (EMIS)]. Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz. 2013;56(12):1609-18.  https://doi.org/10.1007/s00103-013-1855-6  PMID: 24337122 
  33. Fairley CK, Law M, Chen MY. Eradicating syphilis, hepatitis C and HIV in MSM through frequent testing strategies. Curr Opin Infect Dis. 2014;27(1):56-61.  https://doi.org/10.1097/QCO.0000000000000020  PMID: 24275695 
  34. Gray RT, Hoare A, Prestage GP, Donovan B, Kaldor JM, Wilson DP. Frequent testing of highly sexually active gay men is required to control syphilis. Sex Transm Dis. 2010;37(5):298-305. PMID: 20393383 
  35. Tuite A, Fisman D. Go big or go home: impact of screening coverage on syphilis infection dynamics. Sex Transm Infect. 2016;92(1):49-54.  https://doi.org/10.1136/sextrans-2014-052001  PMID: 25954016 
  36. Bremer V, Brockmeyer N, Coenenberg J. S1-Leitlinie: STI/STD-Beratung, Diagnostik und Therapie. [S1 guideline: STI/STD counselling, diagnostic and therapy]. 2015. German. Available from: www.awmf.org/uploads/tx_szleitlinien/059-006l_S1_STI_STD-Beratung_2015-07.pdf
  37. European Centre for Disease Prevention and Control (ECDC). HIV and STI prevention among men who have sex with men. Stockholm: ECDC, 2015. Available from: http://ecdc.europa.eu/en/publications/publications/hiv-sti-prevention-among-men-who-have-sex-with-men-guidance.pdf

Data & Media loading...

Submit comment
Comment moderation successfully completed
This is a required field
Please enter a valid email address
Approval was a Success
Invalid data
An Error Occurred
Approval was partially successful, following selected items could not be processed due to error