Distribution and Incidence

Unlike human nonvenereal treponematoses (pinta, yaws, and endemic syphilis), venereal syphilis has managed to establish a worldwide distribution, although its incidence patterns are somewhat different in developed and developing countries.

The incidence of syphilis, for example, has continuously declined in the Western world since the 1860s, although major wars have momentarily interrupted this trend. After the Second World War, late and congenital syphilis almost disappeared, mainly as a result of public health measures and penicillin. Since the 1950s, however, both primary and secondary syphilis have steadily increased (nearly 29,000 cases in the United States in 1984) with its peak incidence in the 15- to 34-year age group. A strikingly high male/female ratio (2.6:1 in the United States in 1983) is due to a considerable incidence of syphilis in male homosexuals. In 1980, 58 percent of all syphilitic men in England were homosexuals as were 50 percent in the United States (Csonka 1987; Holmes and Lukehart 1987).

In developing countries, syphilis continues to be a widespread disease, although interpretative problems of serologic tests for syphilis make it difficult to estimate the numbers of infected people in those regions. Syphilis is increasing in areas where yaws was previously endemic, such as tropical and equatorial America and Africa, and Southeast Asia. Infected prostitutes seem to play an important role in the spread of syphilis in these areas, most noticeably in the Far East. The risk of congenital syphilis continues to be considerable in many developing countries, resulting in fetal wastage, neonatal mortality, and infant morbidity (WHO 1986; Csonka 1987).

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