Perspective Open Access
Like 0


Syphilis remains a disease of public health importance, with considerable health effects if not treated. Concurrent infection with syphilis and untreated HIV facilitates HIV transmission. The incidence of syphilis in Europe has been increasing, particularly among men who have sex with men (MSM) and in MSM with HIV. However, there is heterogeneity among countries in the case definition used for syphilis and in reported syphilis notification rates. In Ireland, we have undertaken a number of refinements of the national syphilis surveillance system since 2014, including refinement of the laboratory thresholds for notification (rapid plasma reagin 1:16 and/or positive IgM). This article outlines the steps taken and some of the challenges we faced. Our current case definition now accurately reflects the epidemiology of syphilis in Ireland and our current surveillance provides timely information for action, while not reducing the sensitivity of the system too much. For countries where surveillance is driven mainly by laboratory reporting and where obtaining clinical details is challenging, these thresholds for notification may be a pragmatic solution.


Article metrics loading...

Loading full text...

Full text loading...



  1. Hook EW 3rd. Syphilis. Lancet. 2017;389(10078):1550-7.  https://doi.org/10.1016/S0140-6736(16)32411-4  PMID: 27993382 
  2. French P. Syphilis. BMJ. 2007;334(7585):143-7.  https://doi.org/10.1136/bmj.39085.518148.BE  PMID: 17235095 
  3. Soreng K, Levy R, Fakile Y. Serologic testing for syphilis: benefits and challenges of a reverse algorithm. Clin Microbiol Newsl. 2014;36(24):195-202.  https://doi.org/10.1016/j.clinmicnews.2014.12.001  PMID: 28845073 
  4. European Commission. Commission Implementing Decision (EU) 2018/945 of 22 June 2018 on the communicable diseases and related special health issues to be covered by epidemiological surveillance as well as relevant case definitions (Text with EEA relevance.). Official Journal of the European Union. Luxembourg: Publications Office of the European Union 6.7.2018:L 170/1. Available from: https://eur-lex.europa.eu/legal-content/EN/TXT/PDF/?uri=CELEX%3A32018D0945&from=EN%29
  5. Health Protection Surveillance Centre (HPSC). Syphilis in Ireland, 2015. Dublin: HPSC; 2016. Available from: https://www.hpsc.ie/a-z/sexuallytransmittedinfections/syphilis/surveillancereports/File,15870,en.pdf
  6. European Centre for Disease Prevention and Control (ECDC). Syphilis - Annual epidemiological report for 2016. Stockholm: ECDC: 2018. Available from: https://www.ecdc.europa.eu/en/publications-data/syphilis-annual-epidemiological-report-2016
  7. Spiteri G, Unemo M, Mårdh O, Amato-Gauci AJ. The resurgence of syphilis in high-income countries in the 2000s: a focus on Europe. Epidemiol Infect. 2019;147:e143.  https://doi.org/10.1017/S0950268819000281  PMID: 30869043 
  8. Health Protection Surveillance Centre (HPSC). Early infectious syphilis in Ireland, 2017. Dublin: HPSC; 2018. Available from: https://www.hpsc.ie/a-z/sexuallytransmittedinfections/publications/stireports/2017reports/Syphilis%20in%20Ireland,%202017%20(includes%20latest%20trends).pdf
  9. European Centre for Disease Prevention and Control (ECDC). Surveillance systems overview for 2017. Stockholm: ECDC; 2018. Available from: https://www.ecdc.europa.eu/en/publications-data/surveillance-systems-overview-2017
  10. Cronin M, Domegan L, Thornton L, Fitzgerald M, Hopkins S, O’Lorcain P, et al. The epidemiology of infectious syphilis in the Republic of Ireland. Euro Surveill. 2004;9(12):14-7.  https://doi.org/10.2807/esm.09.12.00495-en  PMID: 15677853 
  11. Infectious disease regulations 1981. S.I. No. 390/1981. Dublin: Government of Ireland; 1981. Available from: http://www.irishstatutebook.ie/eli/1981/si/390/made/en/print
  12. Hennessy S. Amendment to laboratory criteria for notification of syphilis cases to Public Health 2016. Dublin: Health Protection Surveillance Centre (HSPC); 2016.
  13. Health Protection Surveillance Centre (HPSC). Early Infectious Syphilis in Ireland, 2016. Dublin: HPSC; 2017.
  14. German RR, Lee LM, Horan JM, Milstein RL, Pertowski CA, Waller MN, et al. Updated guidelines for evaluating public health surveillance systems: recommendations from the Guidelines Working Group. MMWR Recomm Rep. 2001;50(RR-13):1-35. PMID: 18634202 
  15. Health Protection Surveillance Centre (HPSC). Syphilis (Treponema pallidum) and syphilis, congenital and neonatal (Treponema pallidum): Case definitions 2019. Dublin: HPSC. [Accessed: 29 Aug 2019]. Available from: https://www.hpsc.ie/a-z/sexuallytransmittedinfections/syphilis/casedefinitions/

Data & Media loading...

Supplementary data

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