Unsafe sex not main reason for syphilis outbreaks

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Syphilis epidemics are primarily driven by the cyclical nature of the disease rather than changes in sexual behaviour, according to the results of a UK study.

Researchers at Imperial College London analysed data reported to the US Centers for Disease Control and Prevention from 68 cities between 1941 and 2002, and found that rises and falls in the disease followed a distinct pattern that was repeated over a 10-year cycle.

Immediately after an epidemic, immunity in the population was at its highest. It then took time for immunity to drop to a level where a new epidemic could occur, the researchers report in the research journal Nature.

Therefore, the periodic rises in syphilis cases could be explained by falling immunity, rather than by a dramatic increase in unsafe sex practices.

“While we do not dispute the fact that syphilis is transmitted by unsafe sex, our findings suggest that change in population immunity is the main reason for periodic epidemics of syphilis, not change in sexual behaviour,” lead author Dr. Nicholas Grassly commented in a statement.

Grassly’s team compared syphilis case reports with gonorrhoea reports from the same cities and found contrasting results. Despite infecting the same groups, cyclical epidemics of gonorrhoea did not occur because this infection a does not trigger a protective immune response.

Changes in the number of new gonorrhoea cases are therefore more likely to reflect changes in sexual behaviour rather than the cyclical natural phenomenon seen with syphilis.

Grassly added, “As well as analysing previous epidemics, it may also be possible to use these findings to help doctors and sexual health workers predict and prepare for future outbreaks of the disease.”

He noted, “Troughs in the number of cases offer an unprecedented opportunity for eradication of the disease. However, when this opportunity is missed, an epidemic is likely to follow.”

SOURCE: Nature, January 26, 2005.

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