Evolutionary aspects of syphilitic infection in the Republic of Moldova

Abstract

Syphilis was first recognized in Europe in the late 15th century1; its cause, Treponema pallidum subspecies pallidum, was identified four centuries later. The advent of penicillin, together with effective public health measures, led to a significant decline in syphilis in the United States and Europe. However, currently, the incidence of syphilis in the United States has returned to levels not seen in more than 20 years, with the number of cases reported to the Centers for Disease Control and Prevention (CDC) increasing by 81% from 2014 to 2018. Recognition of syphilis, with its varied presentations, can challenge even the most experienced clinicians, and the natural history of both untreated and treated disease can be unpredictable (1). The aim of this study is to estimate the annual incidence of syphilis in the Republic of Moldova from 1953 to 2023, as well as to evaluate the clinical and evolutionary characteristics of this disease in the past 5 years. Materials and Methods A cross-sectional study was conducted, with variables of interest extracted from the annual report forms of dermatovenereologists, presented at the Statistical Department of the Dermatology and Communicable Diseases Hospital over the last 5 years, as well as epidemiological statistical reports from 1953 to 2023. Results The incidence of syphilis in the Republic of Moldova over the past 50 years has had an undulating evolution with significant increases during periods of socioeconomic crisis: after World War II - 1947-1950 when the number of syphilis cases exceeded 100 per 100,000 population, and in the years 1994-1999 when the number of syphilis cases per year ranged from 117.9 in 1994 to 200.7 per 100,000 population in 1996, respectively. The lowest number of syphilis cases in our country was recorded in the period from 1958 to 1964, reaching 5.5 cases per 100,000 population in the years 1961-1962. Over the past 10 years, the incidence of syphilis has varied between 63.7 cases in 2013 and 45.1 cases per 100,000 population in 2023, showing a negative trend. However, according to international statistics, the Republic of Moldova remains at the top in Central and Eastern Europe in terms of syphilis morbidity, with the Russian Federation reporting a syphilis incidence rate of 18.9 cases and EU countries at 8.5 cases per 100,000 population, respectively. The distribution of syphilis cases by gender in the past 5 years has shown a slight predominance of the disease in males, with a male-to-female ratio of 1.3:1. The distribution of syphilis by age in the native population, according to statistical reports, has shown 2 trends: with a predominance of cases in individuals over 40 years old in 2019-2020, changing the trend towards dominant involvement of young people aged 20-29. According to clinical manifestations in patients from the native population, asymptomatic latent forms predominate. Over the past 5 years, 15 cases of neurosyphilis have been reported. The prevalence of syphilis in pregnant women in our country from 2019 to 2023 was less than 0.5%, with congenital syphilis cases also few, under 10 cases per year, which has allowed consecutive validation by the WHO of the elimination of mother-tochild transmission (EMTCT) of syphilis at the national level. Conclusions In the Republic of Moldova, syphilis continues to represent a major sexually transmitted infection with the highest incidence, predominantly affecting young men and manifesting through latent forms. Conversely, congenital syphilis with a rate of under 50 cases per 100,000 live births for several consecutive years has validated the Republic of Moldova as a state with validated EMTCT.