Epidemiological study Syphilis in Latvia 
Epulemiowgy of syphilis 
inLatvia 
A. Rubins, R. Gutmane, S. Rubins, I. Jekabsone and J. Pirsko 
------------- ------------ABSTRACT 
Background: The present paper discusses the epidemiology of syphilis and contains characterization 
of the increase of cases in Latvia. 
Materials and methods: Epidemiologic, clinical and diagnostic data on cases of syphilis in Latvia have 
been summarized. Clinical diagnosis of suspected syphilis was confirmed by positive dark field 
examination or by positive serologic tests far syphylis. 
Results: In 1993, there were 830 recorded syphilis cases in Latvia, in 1994 the number of cases amounted 
to 1521, in 1995 to 2357, in 1996 to 3124, in 1997 to 3008, in 1998 to 2597. 
An analysis is given of syphilis patients according to the age and stage of the disease, secondary syphilis 
being prevalent. 
Conclusions: It has been shown that the increase in syphilis cases is due to lack of prophylactic 
educational measures among the population. Comparative figures dating from various years are 
mentioned. 
Introduction 
Syphilis has quite often been a problem of great persons), then again in 1973 (82.6 cases per 100,000 
concern in Latvia and in a number of other countries persons) and since 1993 a dramatic increase in the 
(1,3,5). Analyzing the incidence of syphilis in Latvia incidence of syphilis has been noted again (Table 1). 
since 1920 one can hardly explain its inte1mittent charac- In 1993, there were 830 recorded syphilis cases in 
ter. Morbiditywas very high in 1922 (310 cases per 100,000 Latvia, in 1994 the number of cases amounted to 1521 , 
acta dermatovenero/ogica A.P.A. Vol 8, 99, No 2 - ---------------------------- J9 
Syphilis in Latvia 
in 1995 to 2357, in 1996 to 3124, in 1997 to 3008, in 
1998 to 2597 (Table 2). Over the period of many years 
there were only 31 AIDS patients and 260 HIV positive 
subjects. Out of them 6 and 2 respectively have died. 
Materials and methods 
Epidemiologic, clinical and diagnostic data on cases 
of syphilis in Latvia have been summarized; syphilis was 
diagnosed clinically and confirmed by finding 
spirochetes or determining serologic tests for syphilis 
(STS). 
Serological methods , used for diagnosis of syphilis 
in Latvia, are the following: 
- rapid diagnostic methods - SED, RPR, VDRL; 
- passive hemaglutination reaction - TPHA; 
- immunofluorescence reactions - IFR abs, IFR abs IgM 
- immunoferment (enzyme) analysis - IFA 
- immobilization test for Treponema pallidum- Nelson 
test 
Results 
Ali results are seen in Tables 1 - 3. As seen in Tables 
1 and 2, in 1994 there were 1521, and in 1997 3008 
recorded syphilis cases in Latvia. Out of them in 1997, 
621 were suffering from primary syphilis, 2362 from 
secondary syphilis , and the duration of illness was over 
3 months in 1950 cases and over 6 months in at least 
1353 cases. These data show that the population bas 
not been sufficiently informed as to the high incidence 
of syphilis and do not visit a doctor. 
Most alarming is the fact that the incidence of syphilis 
is increasing among young people (Table 2). In 1995 in 
the age group of 13 to 14 years and in the age group 15 
to 17 years there were 15 and 156 cases respectively. 11 
children acquired the disease from infected parents and 
15 cases were congenital.In 1996 the figures were as 
follows: 10; 184; 7 and 25 respectively, while in 1997, 
10; 138; 6 and 22. 
Table 1. Dynamics of syphilis morbidity in Latvia (Nr. 
of cases per 100,000 of the population) and two 
biggest cities - Riga and Daugavpils* 
Latvia 23.7 59.3 91.9 124.9 121.3 105.6 
Riga 34.1 94.6 147.4 183.8 167.4 127.2 
Daugavpils 54.2 104.1 125.4 183.9 137.0 133.9 
60 
Epide m io l og i cal study 
The number of cases with congenital syphilis is 
dramatically increasing in children of unemployed 
women, who are not registered with the obstetrician-
gynecologist and see the physician for the first tirne at 
delivery or shortly before. According to the present 
regulations ali pregnant women must register and 
serological analyses for syphilis are to be made during 
pregnancy, i.e., in the 2nd-3rd month as well as in the 
6th-7th month of pregnancy. The distribution of syphilis 
patients according to their nationality was varied: 33.5 
percent were Latvians, 55 percent were Russians, 11.5 
of other nationalities reflecting the distribution of na-
tionalities in Riga. 
The recording and registration of syphilis cases in 
Latvia is carried out by the State centre for Sexually 
Transmitted and Skin Diseases. The monthly registered 
morbidity rates are reported to the State Environment 
and Health Centre that transmits the information on ali 
infectious diseases to the State Statistics Committee. 
In recent years , only one case of tertiary syphilis was 
diagnosed in Latvia (in 1995). 
Discussion 
It should be noted that a rapid rise in the incidence 
of syphilis in USA was observed in the early '90s, when 
20 cases per 100.000 persons (1 ,2) were diagnosed. In 
Eastern European countries the incidence of syphilis in 
1995 was tl1e following: in Russia 177, in Moldavia 173, 
in Belorus 147, in Estonia 69,7, in Lithuania 93, and 
morbidity was dramatically increasing ( 4). In the United 
States this was connected with the high leve! of drug 
addiction - "crack" cocaine use (2). This refers partly to 
the situation in Latvia, as well as to the above countries · 
where the prostitution leve! is very high. 
In 1920, registration of syphilis cases began and the 
high incidence may be explained by the post-war period 
(World War I) and lack of medications. 
The years of 1939-1945, were the tirne ofWorld War 
II and registration of syphilis cases was not taking place. 
Fluctuations in syphilis morbidity are parallel to 
changes in the economic and political situation, increa-
sed migration of peoples, expanded imports and disse-
mination of pornographic literature. Since 1993 the rise 
in syphilis morbidity has been due to prostitution, adver-
tised but medically uncontrolled, and due to the rapid 
rise in the leve! of unemployment, alcohol abuse and 
drug addiction. 
Pornographic and sex literature was brought to 
Latvia and has acquired a mass character lowering the 
moral and ethical leve! of the population, particularly 
that of teenagers. Advertising of prostitution is sprea-
acta dermatovenerologica A.P.A. Vol 8, 99, No 2 
Epidemiological s t udy SyphYlis in Latvia 
Table 2. Syphylis in Latvia in 1993 - 1998. Nuber of cases. 
0-4 2 5 26 32 28 20 
(1 congenital) (2 congenital) (15 congenital) (25 congenital) (22 congenital) (15 congenital 
5-9 2 
10-12 1 1 
13-14 6 4 15 10 10 5 
15-17 77 108 156 184 138 119 
18-19 103 153 200 261 185 184 
20-29 411 774 1104 1361 1256 1073 
30-39 169 347 552 786 799 684 
40-and more 61 130 304 499 572 509 
cling. About 200 clubs offering services by prostitutes 
have sprung up in Latvia, though prostitution has not 
been legalizecl. Ali this contributes to the clramatic rise 
in the inciclence of syphilis (3) . 
The above-mentionecl facts have createcl a situation 
in which prostitutes have become meclically uncon-
trollable. 
Conclusions 
In the last 5 years syphilis in Latvia has hacl a ten-
clency to spreacl. In 1998, however, this process slowecl 
clown. From 1993 to 1997 seconcla1y syphilis was often 
cliagnosecl. Increasingly, younger persons are getting 
infectecl. 
To reduce the morbidity and spread of venereal 
diseases the following measures are recommenclecl: 
l. Education activities - articles in the press, addressing 
people by radio and on TV; 
2. Education at school explaining possibilities of getting 
infected, syphilis prevention ancl treatment, the nece-
ssity of using concloms; 
3. Passing a law on prostitution ancl regular medica! 
check-ups of prostitutes . 
Table 3. Characterization of syphilis patients in Latvia, 1993-1998 
Syphilis primaria 212 395 613 729 621 416 
Syphilis secundaria 614 1121 1724 2362 2362 2155 
Syphilis congenita 2 15 25 22 15 
Syphilis latens tarda 4 3 5 8 3 11 
Syphilis tertiaris 
acta dermatovenero/ogica A.P.A. Vol 8, 99, No 2 ------------------- --- --- ----- 61 
Syphilis in Latvia Ep i d e m i o l o g i c a I s t u d y 
Jl E F :E: R E N C E S l. Goens JL, Janniger CK,Wolf KO. Dermatologic and Systemic Manifestations of Syphilis. American Family 
Physician 1994; 50 (5):1013-20. 
AUTHORS' 
ADDRESSES 
62 
2. Buntin DM, Rosen T, Lesher JLJr, Platnic KH, Brademas ME, BergerTG. Sexually transmitted diseases: 
bacterial infections. Committee on Sexually Transmitted Diseases of the American Academy ofDermatology. 
J Amer Acad Dermatol 1991; 25: 287-99. 
3. Rubins S, Janiger CK, Schwartz RA. Congenital and Acquired Early Childhood Syphilis. Cutis 1995; 
56: 132-6. 
4. Gromiko Al. Epidemiology of sexually transmitted diseases in Eastern European states. Journal Sexually 
Transmitted diseases 1996; 6: 22-5 (in Russia, Moscow ISSN 0136-0048). 
5. Edwards S, Carne C. Oral sex and the transmission of non-viral STis. Journal Sexually Transmitted 
infections 1998; 78 (2): 95-100. 
An:dris Y. Rubins, MD, PhD, Professor and Chairman, Medical Academy qf 
Latvia, Department oj Dermatovenereology, Dzirciema street 16, Riga, Latvia, 
LV-1007 
Rita Gutmane, MD, same addres 
Sylvester Rubins, MD, same address 
flze Jekabsone, Head oj STD States clinical center, Pernavas street 70, Riga, 
LatviaLV-1069 
Judite Pirsko, same address 
acta dermatovenero/ogica A.P.A. Vol 8, 99, No 2