Syphilis: Epidemiological Aspects


Syphilis continues to represent a significant public health issue. The number of cases globally remains high at over ten million newly infected patients each year, with highest rates seen in countries of low income. The main mode of transmission is by sexual contact, with men who have sex with men, co‐infection with human immunodeficiency virus (HIV) and the sexually promiscuous particularly at risk. Infection rates are also linked with times of war and social upheaval; this is also true of other sexually transmitted diseases.

Prevention of new cases is clearly desirable. Most major health organisations (including the CDC and WHO) have elimination plans which rely on education, promotion of safe sexual practices and screening of high‐risk individuals at the core of the strategy.

Key Concepts:

  • Clinical differences in the treponematoses have been attributed to adaptation of the organism to climatic factors.

  • An African rather than an American origin is suggested for syphilis.

  • The control of syphilis by public health measures is exemplified by a lower incidence of syphilis in Europe and North America than the rest of the world.

  • An increased incidence in syphilis is found associated with wars and civil disturbance.

Keywords: syphilis; treponematosis; origin of syphilis; epidemiology

Figure 1.

Centers for Disease Control and Prevention. Sexually Transmitted Disease Surveillance 2007 Supplement, Syphilis Surveillance Report. Atlanta, GA: U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, March 2009. (a) Reported cases by stage of infection over a 50‐year period. (b) Reported cases by risk factor demographics.

Figure 2.

Syphilis in Europe: (a) number of diagnoses and (b) rate of diagnosis. By courtesy Van der Laar and Fenton (see also Fenton et al., ).

Figure 3.

Total number of infectious (‐ ‐ ‐ ‐) and noninfectious (–) cases of syphilis reported by UK genitourinary clinics from 1971 to 1996. The prolonged time of discovery from the time of infection of late or latent noninfectious syphilis is reflected in the ‘crossover’ of the noninfectious curve by the infectious disease curve in 1986. The phenomenon has previously been described in the UK (Felton, ).

Figure 4.

Reported incidence of primary, secondary and congenital syphilis. Results from a nationwide surveillance programme. Adapted from Chen et al. .



Aseffa A, Ishak A, Stevens R et al. (1998) Prevalence of HIV, syphilis and genital Chlamydia infection among women in north‐west Ethiopia. Epidemiology and Infection 120: 171–177.

Borisenko KK, Tichenova LI and Renton AM (1999) Syphilis and other sexually transmitted infections in the Russian Federation. International Journal of STD and AIDS 10: 665–668.

Brazilian Ministry of Health (2004) STD incidence estimation in Brazil Report. National AIDS Programme.

Castro R, Prieto E, Aguas A et al. (2009) Molecular subtyping of Treponema pallidum subs pallidum in Lisbon, Portugal. Journal of Clinical Microbiology 47: 2510–2512.

CDC, Sexually Transmitted Disease Surveillance (2009) Available at

Chen ZQ, Zhang GC, Gong XD et al. (2007) Syphilis in China: results of a national surveillance programme. Lancet 369: 132–138.

Cook DC and Powell ML (2005) Piecing the puzzle together: North American treponematosis in overview. In: Powell ML and Cook DC (eds) The Myth of Syphilis, pp. 442–479. Gainesville: University Press of Florida.

Dougan S, Evans B and Elford J (2007) Sexually transmitted infections in Western Europe among HIV‐positive men who have sex with men. Sexually Transmitted Diseases 34: 783–790.

Felton WF (1973) Estimate of annual incidence of undiscovered syphilis. British Journal of Venereal Diseases 49: 249–255.

Fenton K, Boccacia D, Lowdenes C et al. (2003) On behalf of the ESSTI Network. The record of infectious disease in Western Europe. Eighth World STI/AIDS Meeting 20: 300–309.

Gerbase AC, Rowley JT and Mertens TE (1998) Global epidemiology of sexually transmitted diseases. Lancet 351(suppl. 3): 2–4.

Harper KN, Ocampo PS, Steiner BM et al. (2008) The origin of treponematosis: a phylogenetic approach. PLoS Neglected Tropical Diseases 2(1): e148.

Joesoef MR, Linnan M, Barakbah Y et al. (1997) Patterns of sexually transmitted diseases in female sex workers in Surabaya, Indonesia. International Journal of Sexually Transmitted Diseases and AIDS 8: 576–580.

Love AG and Davenport CB (1918) Defects found in drafted men. Government Printing Office, Washington, DC, also U.S. War Department, Annual Report 1918 (1920) Government Printing Office, Washington, DC, p. 34.

Mikalová L, Strouhal M, Čejková D et al. (2010) Genome analysis of Treponema pallidum subsp. pallidum and subsp. pertenue strains. Most of the genetic differences are localised to six regions. PLoS One 5: e15713 (Dec. 29). MMWR/Feb 11 2011/vol. 60/no.5.

Mulligan CJ, Norris SJ and Lukehart SA (2008) Molecular studies in Treponema pallidum evolution towards clarity. PLoS Neglected Tropical Diseases 2(1): e184.

Rothschild BM and Rothschild C (1995) Treponemal disease revisited: skeletal discriminators for yaws, bejel, and venereal syphilis. Clinical Infectious Diseases 20: 1402–1408.

Rothschild BM, Calderon FL, Coppa A and Rothschild C (2000) First European exposure to syphilis: the Dominican Republic at the time of Columbian contact. Clinical Infectious Diseases 31: 936–941.

Rothschild BM (2005) History of syphilis. Clinical Infectious Diseases 40: 1454–1463.

Sangare L, Meda N, Lankoande S et al. (1997) HIV infections among pregnant women in Burkina Faso: a nationwide serosurvey. International Journal of Sexually Transmitted Diseases and AIDS 8: 646–651.

Savage EJ, Hughes G, Ison C and Lowndes CM (2009) The European Surveillance of Sexually Transmitted Infections (ESSTI) network. Syphilis and gonorrhoea in men who have sex with men: a European overview. European Surveillance 14(47): pii=19417.

Symchych N (2009) Venereal syphilis: the mystery continues. Journal of the Manitoba Anthropology Students’ Association 28: 66–82.

Tantalo LC, Lukehart SA and Marra CM (2005) Treponema pallidum strain‐specific differences in neuroinvasion and clinical phenotype in a rabbit model. Journal of Infectious Diseases 191: 75–80.

Tichonova L, Borisenko K, Ward HH et al. (1997) Epidemics of syphilis in the Russian Federation: trends, origins, and priorities for control. Lancet 350: 210–213.

Tikhonova L, Salakhov E, Southwick K et al. (2003) Congenital syphilis in the Russian Federation: magnitude, consequences and determinants. Sexually Transmitted Infections 76(2): 106–110.

Van den Hoek A, Yuliang F, Dukers NH et al. (2001) High prevalence of syphilis and other sexually transmitted diseases among sex workers in China: potential for fast spread of HIV. AIDS 15(6): 753–759.

Van der Laar M and Fenton K (2003) Resurgence of syphilis in Europe. ISSTDR website: 15th Biennial Conference. Abstract: 649.

Von Hunnius TE, Robbers CA, Boylston A and Saunders SR (2006) Histological identification of syphilis in pre‐Columbian England. American Journal of Physical Anthropology 129: 559–566.

Yakubovsky A, Sokolovsky E, Miller W et al. (2006) Syphilis management in St Petersburg, Russia 1995–2001. Sexually Transmitted Diseases 33: 244–249.

Further Reading

Cates W Jr, Rothenberg RB and Blount JH (1996) Syphilis control: the historical context and epidemiological basis for interrupting sexual transmission of Treponema pallidum. Sexually Transmitted Diseases 23: 68–75.

Fitzgerald MR, Ahmed‐Jushuf I, Radcliffe KW et al. (2002) Revised UK national guidelines on sexually transmitted infections and closely related conditions 2002. Sexually Transmitted Infections 78: 81–82.

Gjestland T (1955) The Oslo study of untreated syphilis: an epidemiologic investigation of the natural course of the syphilitic infection based on a restudy of the Boeck‐Bruusgaard material. Acta Dermato‐Venereologica (Stockh) 55(suppl. 34): 3–368.

Goh BT and Voorst Vader PC (2001) European guidelines for the management of syphilis. International Journal of STD and AIDS 12(suppl. 3): 14–26.

Oriel JD (1994) The Scars of Venus: A History of Venereology. London: Springer.

Reverby S (2009) Examing Tuskagee: The Infamous Syphilis Study and its Legacy. Chapel Hill: University of North Carolina Press. [Contains reference to all 13 Reports of the original Tuskagee Group].

Workowski KA and Levine WC (2002) Sexually transmitted diseases treatment guidelines 2002. Center for Disease Control Prevention. MMWR Recommendations Report 51 (RR‐6), pp. 18–29.

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Wright, David J, Norris, Steven J, Dhillon, Rishi H‐P, and Edmondson, Diane G(Jan 2012) Syphilis: Epidemiological Aspects. In: eLS. John Wiley & Sons Ltd, Chichester. [doi: 10.1002/9780470015902.a0023926]