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BMJ No 7114 Volume 315 Letters Saturday 18 October 1997
Incidence of early syphilis acquired in former Soviet Union is increasingEditorSince 1990 there has been a growing epidemic of syphilis in the countries of the former Soviet Union.(1) The Russian health ministry recently reported a 15-fold increase in the incidence of syphilis in adults and a 20-fold increase in children.(2) Most cases are attributed to sexual transmission. Explanations for this phenomenon include the rapid growth of the sex industry, including child prostitution; increasing numbers of homeless people and refugees in Russian cities; poor diagnostic facilities; punitive legislation reducing the likelihood of presentation to treatment services; and limited or inadequate treatments. Effects of this epidemic have already been noted in other countries: in Finland the incidence of syphilis has increased considerably since the b We undertook a retrospective review of cases of infectious syphilis to assess the impact of the Russian epidemic on this genitourinary medicine clinic in central London. Eleven cases were treated between January 1995 and December 1996. All patients had signs of primary or secondary syphilis or positive serological findings, or both. Six patients could only have acquired syphilis as a result of sexual contact with a Russian partner, either in Russia or in Britain. These results show that a substantial proportion of cases of syphilis treated in this clinic can be attributed to the epidemic in Russia. Similar cases have recently been reported from other centres.(4) The Public Health Laboratory Service has recorded that, since routine reference laboratory reporting of syphilis began in April 1994, the disease was acquired abroad in 48 of 87 cases (A Nicoll, personal communication). Of these, the largest proportion (14/87) were acquired in eastern Europe. We have observed an increasing number of Russian commercial sex workers attending our outreach service in Soho, and this phenomenon has also been reported in the local press.(5) The incidence of syphilis has decreased dramatically in Britain since the early 1980s, and the disease is therefore increasingly easy to overlook. As it may present in various ways, patients may be seen by clinicians in many specialties. Surveillance data from the Public Health Laboratory Service show that 28% of cases of infectious syphilis are reported from sources other than genitourinary medicine clinics. These cases illustrate the need for increased vigilance for early syphilis, especially in people who have had sexual contacts in the former Soviet Union. Jane Deayton
Patrick French
References 1 Linglof T. Rapid increase of syphilis and gonorrhoea in parts of the former USSR. Sex Transm Dis 1995;22:160-1. 2 Ingram M. Syphilis soars in Russia. BMJ 1995;311:78. 3 Hiltunen-Back E, Haikala O, Koskela P, Reunala T. Increase of syphilis in Finland is related to the Russian epidemic. Eurosurveillance 1996;1:1-2. 4 Sherrard J, Luzzi G, Edwards A. Imported syphilis and other sexually transmitted infections among UK travellers to Russia and Poland. Genitourin Med 1997;73:75. 5 Evening Standard ES Magazine 1996 Oct
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