Syphilis and gonorrhoea in Slovenia 
Epidemiological study 
THE CURRENT SITUATION_ CONCERNING 
SYPHILIS AND GONORRHOEA IN SLOVENJA 
M. Potočnik and M. Barač 
ABSTRACT 
The epidemiological situation of syphilis and gonorrhoea in Slovenia in 1994 is the subject-matter of the 
present paper. During the past twenty years, sypbilis was on a distinctive decline in Slovenia. In 1994, 36 
cases of early sypbilis were registered, representing an incidence of 1.82 per 100 000 inbabitants and equaling 
the situation 12 years ago. A continuous decline in gonorrhoea was also registered, tbe incidence in 1994 
being 10.7 per 100 000 inbabitants, but due to known reasons tbis data are not reliable . Since Slovenia 
borders tbe crisis territories of former Yugoslavia, sexually transmitted diseases demand particular attention 
of public bealtb autborities and also close cooperation of venereologists from tbe countries of tbe Alps-
Danube-Adriatic region. 
KEY WORDS 
syphilis, gonorrhoea, epidemiology, Slovenia. 
INTRODUCTION 
Slovenia bas very reliable data on formerly venereal 
and presently termed classic sexually transmitted 
diseases (STD) (sypbilis, gonorrboea, ulcus molle, 
lympbogranuloma venereum) since reporting tbem 
bas been compulsory by law since 1948 (1). Tbe 
patients are registered and in tbe majority of cases 
also treated in 9 dermatological outpatient STD 
clinics tbat cover tbe needs of tbe entire country 
(population 1 990 623). The data are reported montbly 
to tbe STD Registry Office at tbe Department of 
Dermatology of tbe Ljubljana University Medica! 
Centre wbicb provides a cumulative annual report 
and analysis. 
acta de:rriatovenerologica A.P A. Vol 4, 95, No 3 
During tbe past 20 years, tbe incidence of classical 
STD in Slovenia, sypbilis and gonorrhoea, followed 
tbe trend in western Europe (2). Sypbilis increased 
in tbe seventies, started to decline toward tbe end 
of tbe decade and followed sucb a persistent decline 
tbat in the years 1992 to 1993 only two cases of 
early sypbilis were registered in tbe entire country, 
meaning an incidence of 0.10 per 100,000 inbabitants. 
Surprising were tbe data for 1994 wben 36 cases of 
early sypbilis were registered in tbe entire country, 
meaning an incidence of 1.82 per 100 000 inbabitants 
(1,2,3, 4,5) (Fig. 1). 
Just like in otber European countries, during tbe 
second World War and in tbe following peri9d 
gonorrboea was widely spread in our country. In 
141 
Syphilis and gono"hoea in S/ovenia 
the early fifties the disease started to decline. It 
then began to increase again, reaching its climax in 
1975, after that it began to decline steadily (1,2,3,4). 
Thus the incidence rate in 1994 amounted to 10.7 
per 100 000 inhabitants (5) (Fig. 2). 
ci. o 
30 ~--------- ------- - ~ 
25 ++---- - -----------------1 
~20 +-+- -- - - --------- - - --< 
g 
§15 +-r--- -___,,~--+-',,_,,f---- -- -----< 
~ 
~10 +--+-----+-+-~---+---------< 
1ii 
C:: 
Fig. l . Rates of early syphilis in Slovenia, 1951-1994. 
Both the increase in early syphilis prevalence as 
well as the decline, in gonorrhoea merit a detailed 
analysis which will provide the guidelines for an 
effective repression of these two as well as other 
STO. 
160 ~ --- ----------- ----, 
140 +--------+--'c---1---\~-- - --- -i 
g. 120 +--- ---------------------- - -------< 
Q. 
g 100 +------.+-'H------------ -------< 
o 
~ 80 +---- A-+-------------1---------< 
8. 60 ++---------- --------- ---------< 
.!! rl_ 40 +-~-- - ------- ------+--------< 
20 +--------------- ---..---i 
o -4-+++t-+-+++-+-HH-t-++t-+-+++++,H-t-++H-t++++-t-+++t-H-tf 1~1~1m1-1=1_,_,m,=1m1~1=1~1m1m 
YEARS 
Fig. 2. Rates of gonorrhoea in Slovenia, 1951-1994. 
The study includes ali patients with established 
early syphilis or gonorrhoea who were reported and 
in most cases also treated at the 9 dermatological 
outpatient STO clinics in Celje, Nova Gorica, Koper, 
Kranj, Ljubljana, Maribor, Murska Sobota, Novo 
mesto and Ravne. 
Syphilis and gonorrhoea were observed with regard 
to the stage of disease (syphilis only), geographical 
region, sex, age, profession and marital status of the 
patient, whether the patient had recovered from a 
previous venereal disease, whether the infection 
occurred under the influence of alcohol, following 
intercourse with a prostitute, in Slovenia or abroad. 
142 
RESULTS 
Early syphilis includes primary, secondary and 
early Iatent cases. In 1994, 36 cases of early syphilis, 
which had been on the decline since 1974, were 
discovered and treated in Slovenia (Tab. 1). Out of 
the patients with early syphilis, 25 were men (69.4%) 
and 11 women, (30.6%). 15 patients (41.7%) were 
married, 19 (52.8%) single and 2 (5.5%) were 
widowers. Intercourse with a prostitute was the 
source of infection with syphilis in 3 patients (8.4% ). 
2 patients (5,6%) previously had a venereal disease. 
Under the influence of alcohol, 6 patients (16.7%) 
had become infected with syphilis. Intercourse with 
a prostitute was the source of infection in 3 patients 
(8.4% ). The source of infection was established in 
15 patients (41.7%), in 21 (58.3 %) it could not be 
established. The infection occurred in Slovenia in 25 
cases (69.4%) and abroad in 11 cases (30.6%). 
In 1994, 9 cases of late syphilis (8 cases of latent 
and 1 case of neurosyphilis) were discovered and 
treated. Since 1986 no case of juvenile congenital 
syphilis bas been discovered. 
The prevalence of gonorrhoea (all forms) is on 
the decrease since 1975, so that in 1994 only 211 
cases were discovered and treated (Tab. 2). 156 of 
the patients were men (74%) and 55 women (26% ). 
59 patients (28%) were married, 122 (57.8%) single, 
9 ( 4.3%) divorced and for 21 (9. 9%) no data were 
available. 29 ( 13. 7%) had previously had a venereal 
disease. Under the influence of alcohol 21 (9,9) 
patients had become infected. The intercourse with 
a prostitute was the source of infection in 8 patients 
(3.8% ). The source of infection was established in 
99 patients ( 46.9% ).The place of infection with 
gonorrhoea was in Slovenia in 164 cases (77.7% ), in 
47 cases (22.3%) the infection occurred abroad. 
DISCUSSION 
The highest incidence of syphilis was in the region 
of Ljubljana, the administrative and industrial centre 
at international crossroads. It was also high in the 
industrial region of Celje, whereas in the Koper 
region with its international seaport, where according 
to data from literature ( 4) a higher incidence might 
have been expected, it only amounted to 0.73 per 
100,000 inhabitants. 
The male-female ratio is in accordance with data 
from literature (5,6,7). No new case of syJ?hilis was 
registered in the age group up to 15 years, the 
acta dermatovenerologica A.P.A. Vol 4, 95; No 3 
Syphilis and gonorrhoea in Slovenia 
Tab. l. Early syphilis - according to geographical regions in 1994 
Region Number of cases 
Celje 8 
Nova Gorica o 
Koper 1 
Kranj o 
Ljubljana 25 
Maribor o 
Murska Sobota o 
Novo mesto 1 
Ravne na Koroškem 1 
Slovenia 36 
majority of cases were registered in the age group 
from 30 to 39 years with men prevailing (90% ). 6 
patients ( 16.7%) belong to the age group between 
15 and 19, and tbis group demands special attention. 
The majority of early syphilis cases were among 
industrial workers (39% ). With regard to marital 
status it was established that most patients with 
early syphilis were single (52.8% ). The source of 
infection could only be ascertained · in 41.7%, which 
is below the percentage quoted by west European 
authors (7,8). The majority of infections (69.9%) 
were acquired in Slovenia, similar data are also 
valid far Switzerland (61 % ) (8,9). Intercourse with a 
prostitute is presumably the source of infection in 3 
patients (8.4%), but these as well as data regarding 
intoxication with alcohol are unreliable. 
The number of newly discovered and so far 
untreated cases of late syphilis is now lower than it 
used to be in past years. In 1994, 8 cases of latent 
and one case of neurosyphilis were registered. Most 
cases were discovered during regular blood donations 
% 
22.2 
O.O 
2.8 
O.O 
69.4 
o.o 
o.o 
2.8 
2.8 
100.0 
Number of cases/100 000 
pop. in the region 
3.6 
o.o 
0.7 
o.o 
4.2 
O.O 
O.O 
0.7 
0.7 
1.8 
and some were revealed during pregnancy screening 
tests. 
No case of congenital syphilis was discovered in 
our country in 1994. The most recent case of 
juvenile congenital syphilis was discovered in 1986 
and a case of late congenital syphilis in 1989. These 
data are very encouraging since in contrast to the 
situation in the USA where between 1981 and 1991 
congenital syphilis was on the increase ( 10). With 
regard to the fact that this form of syphilis is often 
related to drug addiction (2) which is also increasing 
in our country, serological tests far syphilis should 
be carried out consequently in pregnant women. 
Like in Western Europe, the number of gonorrhoea 
cases, including ali stages and forms of the disease, 
has been decreasing steadily since 1981 (3,5,6). 
Thus the incidence in Slovenia decreased from 19.8 
per 100.000 inhabitants to 10.7 during the past five 
years, which means 211 cases. Morbidity was highest 
in the Ljubljana region (54.4% ). The male female 
ratio was approximately 3:1, as in ali past years. 
Tab. 2. Gonorrhoea - according to geographical regions in 1994 
Region Number of cases % Number of cases/100 000 
pop. in the region 
Celje 33 15.6 15.0 
Nova Gorica 5 2.4 4.8 
Koper 4 1.9 2.9 
Kranj 7 3.3 3.6 
Ljubljana 115 54.4 19.5 
Maribor 21 9.9 6.0 
Murska Sobota 1 0.5 0.8 
Novo mesto 13 6.2 9.8 
Ravne na Koroškem 12 5.7 9.8 
Slovenia 211 100.0 10.7 
acta dermatovenerologica A.P.A. Vol 4, 95, No 3 143 
Syphilis and gonorrhoea in Slovenia 
The largest number of temale patients was registered 
and treated in the regions of Celje, Ravne and 
Ljubljana (34-29% ). The majority of patients were 
aged between 20 and 29 (50.7%) and between 30 
and 39 (27.0% ). 7.6% of patients belong to the age 
group of 15 to 19, there was no case under the 
age of 15. Most patients (17.5%) were employed in 
industry, a relatively high percentage was in transport 
and catering. '- 57.8% of the patients were single, 
13.7% had had a previous venereal disease. 3.8% 
had become infected during intercourse with a 
prostitute, but tor one third of all the patients such 
data are not available. Besides, these data as well 
as those regarding intoxication are unreliable. The 
source of infection was established in 46.9% of 
patients, 22.3% had been infected abroad, mostly 
in the countries of former Soviet Union and 
Yugoslavia. In Switzerland the percentage of patients 
who had been infected with gonorrhoea abroad 
amounts to 37% (9). 
CONCLUSIONS 
1. According to data from our country for the year 
1994, syphilis is on the increase again after almost 
25 years of decreasing. 
2. The higher incidence of infections with syphilis is 
presumably also the consequence of changed social 
conditions in the regions of former Yugoslavia and 
Soviet Union, of poorer living conditions, illegal 
prostitution and the spread of drug addiction. A 
possible explanation for the increase of syphilis 
could be found m Burckhardt's prediction of a 
higher incidence of this disease around the year 
1995 (11). 
3. Due to not always exact diagnostic procedures, 
not strict reporting of cases and the use of antibiotics 
by population at large, the data regarding the incidence 
of gonorrhoea are not completely reliable. 
4. The present epidemiological situation concerning 
syphilis and gonorrhoea, as well as the remaining 
STD, demands the cooperation of all physicians in 
the country. Since the countries of the Alps-Danube-
Adriatic broader area are exposed to the immigration 
currents from the former Eastern bloc states a close 
cooperation of corresponding Puhlic Health Authorities 
should be promoted in order to prevent the spread 
of STD. 
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AUTHORS' ADDRESSES 
144 
Marko Potočnik, MD, DMD, dermatovenerologist, Department of dermatology, Clinical Centre 
61000 Ljubljana, Zaloška 2, Slovenia 
Miloš Barač, MD, dermatovenerologist, Department of dermatology, General Hospital 
62000 Maribor, Ljubljanska 5, Slovenia 
acta dermatovenerologica A .P A. Vol 4, 95, No 3