TECHNICAL REPORT Syphilis and congenital syphilis in Europe A review of epidemiological trends (2007–2018) and options for response www.ecdc.europa.eu ECDC TECHNICAL REPORT Syphilis and congenital syphilis in Europe A review of epidemiological trends (2007–2018) and options for response This report was produced by Aitana Morano Vazquez, Otilia Mårdh, Gianfranco Spiteri and Andrew J Amato Gauci, of the European Centre for Disease Prevention and Control (ECDC). Acknowledgements The authors would like to thank Raj Patel (IUSTI Europe), Magnus Unemo (Örebro University Hospital, Sweden), Ian Simms (Public Health England, UK), Tom Peterman (Centers for Disease Control and Prevention, USA) and Melanie Taylor (WHO, Switzerland, and CDC, USA) for their invaluable input in reviewing this document. Credit is also due to Ana-Belen Escriva from the ECDC Library for developing the search strategies for the two literature reviews and to Anastasia Pharris, ECDC, for providing support for the systematic literature review. Suggested citation: European Centre for Disease Prevention and Control. Syphilis and congenital syphilis in Europe – A review of epidemiological trends (2007–2018) and options for response. Stockholm: ECDC; 2019. Stockholm, July 2019 ISBN 978-92-9498-343-5 doi: 10.2900/454006 Catalogue number TQ-02-19-499-EN-N © European Centre for Disease Prevention and Control, 2019 Cover picture: © Science Photo Reproduction is authorised, provided the source is acknowledged. For any use or reproduction of photos or other material that is not under the EU copyright, permission must be sought directly from the copyright holders. ii TECHNICAL REPORT Syphilis and congenital syphilis in Europe Contents Abbreviations ................................................................................................................................................ v Executive summary ........................................................................................................................................ 1 Background and objectives ........................................................................................................................ 1 Methods ................................................................................................................................................... 1 Results .................................................................................................................................................... 1 Epidemiology........................................................................................................................................ 1 Options for public health response ......................................................................................................... 2 Background ................................................................................................................................................... 4 1.1 Background ........................................................................................................................................ 4 1.2. Disease background ........................................................................................................................... 4 1. Methods .................................................................................................................................................... 6 1.1 Surveillance data ................................................................................................................................. 6 1.2 Literature review ................................................................................................................................. 6 1.2.1 Literature review on syphilis epidemiology ...................................................................................... 6 1.2.2 Systematic review on options for response ..................................................................................... 7 1.2.3 Study selection strategy ................................................................................................................ 8 1.3 Surveys among Member State experts ................................................................................................ 10 2 Results ..................................................................................................................................................... 11 2.1 Surveillance data analysis .................................................................................................................. 11 2.1.1 Gender ...................................................................................................................................... 11 2.1.2 Age ........................................................................................................................................... 12 2.1.3 Transmission, HIV status and syphilis stage .................................................................................. 13 2.2 Epidemiological review: outbreaks and trends ...................................................................................... 16 2.2.1 Outbreaks and epidemics ............................................................................................................ 16 2.2.2 Rising trends .............................................................................................................................. 17 2.2.4 Other issues related to syphilis .................................................................................................... 20 2.2.5 Congenital syphilis ...................................................................................................................... 20 2.2.6 Social determinants .................................................................................................................... 21 2.3 Survey among Member States ............................................................................................................ 21 2.3.1 Overall ...................................................................................................................................... 21 2.3.2 Syphilis surveillance .................................................................................................................... 21 2.3.3 Congenital syphilis surveillance .................................................................................................... 21 2.3.4 Response activities ..................................................................................................................... 22 2.4 Systematic literature review on public health response ......................................................................... 22 2.4.1 Response to outbreaks or increases in syphilis among adults .......................................................... 22 2.4.2 Responses to increases in congenital syphilis infections ................................................................. 28 3 Conclusions and options for public health response ...................................................................................... 31 Epidemiology review ............................................................................................................................... 31 Options for public health response ........................................................................................................... 31 Enhanced screening of populations at risk ............................................................................................. 32 Screening in outreach settings ............................................................................................................. 32 Partner notification ............................................................................................................................. 32 Education........................................................................................................................................... 32 Using social media .............................................................................................................................. 32 Biomedical interventions ...................................................................................................................... 33 Case management (treatment) ............................................................................................................ 33 Establishing comprehensive outbreak response ..................................................................................... 33 Prevention of congenital syphilis .......................................................................................................... 33 Strengths and limitations of this report ..................................................................................................... 34 References .................................................................................................................................................. 35 Annex 1. Epidemiology data on syphilis and congenital syphilis, EU/EEA countries 2007–2017 ............................ 50 Annex 2. Search strategy .............................................................................................................................. 52 Annex 3. Member State survey questionnaire ................................................................................................. 58 Annex 4. Summary tables for literature review on the epidemiology ................................................................