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..



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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]