Syphilis and other sexually transmitted infections in the Russian Federation.

The countries of the former Soviet Union are currently experiencing major epidemics of sexually transmitted infections (STIs). By 1997 rates of syphilis notification in the Russian Federation had risen to 277 per 100,000 total population, a 43-fold increase over 1989 levels, with rises proportionally larger among young women. Epidemics of gonorrhoea occurred earlier in Russia with official notification rates rising from 105 per 100,000 in 1987 to 232 per 100,000 in 1993; and exceeded one per 100 among both young men and young women in that year. The true incidence of gonorrhoea is certainly much higher. These STI epidemics cause direct suffering and may be important in significantly enhancing the transmission of human immunodeficiency virus (HIV), in the context of liberalization of sexual behaviour, and epidemics of injecting drug use and related HIV transmission. This paper reviews recent epidemiological trends in syphilis and other STIs in Russia against the background of existing mechanisms for the control of these infections.

PIP: This paper reviews recent epidemiological trends in syphilis and other sexually transmitted infections (STIs) in the Russian Federation against the background of existing mechanisms for the control of these infections. The rate of syphilis rose from 4.2 per 100,000 in 1988 to 277.3 per 100,000 in 1997. Furthermore, the gonorrhea epidemic occurred in Russia with rates rising from 105 per 100,000 in 1987 to 232 per 100,000 in 1993. The complex interplay of political, economic and social change have substantially affected the average period for which people with syphilis and other STIs remain infectious. These STI epidemics enhance the transmissibility of HIV. The syphilis epidemic, combined with changes in sexual behavior, has increased travel and migration. The rapid increase in the number of injecting drug users has caused the STI epidemic in Russia and other Eastern European countries. Facing these epidemics, the Ministry of Health has developed a program for controlling the outbreak of STIs with clear objectives and priorities for action. These efforts seek to expand health promotion and primary prevention activities targeted at high risk-groups and young people.

The control and management of the sexually transmitted diseases: a comparison of the United Kingdom and the Russian Federation.

During the last 20 years, both the United Kingdom and the Russian Federation have seen changes to clinical services for sexually transmitted diseases (STDs) health systems and other mechanisms through which STDs are controlled. In the UK these changes followed the description of the acquired immunodeficiency syndrome (AIDS) and the human immunodeficiency virus (HIV); its causal agent. In Russia, the breakdown of the Soviet Union following glasnost and perestroika, and its associated political, social and economic changes generated substantial developments to the ideological and legislative framework within which STD control is achieved as well as a revolution in the financial base upon which clinical STD services operate. The purpose of this paper is to sketch these developments in STD services within the 2 countries to provide a context for the series of papers presented in this edition.

PIP: This paper examines developments in the control and management of sexually transmitted diseases (STDs) in the United Kingdom and the Russian Federation. There have been substantial changes in the clinical services for STD health systems and other mechanisms through which the disease is controlled. In England and Wales, these clinical services have been dictated by the public health response to AIDS and HIV, both in terms of control, and resources for innovation and development. The principles of voluntary, open and confidential services have been maintained within genitourinary medicine. Furthermore, services have become more patient-focused and the role of non-statutory organizations and patients in service, and intervention development has grown. In Russia, since glasnost and perestroika, there has been considerable progress in a similar direction with increasing levels of confidentiality, greater coordination of services, and the development of activities in primary prevention at a time of economic difficulty and the outbreak of the syphilis epidemic. The key areas for development include the following: securing improvements to ethical and humane quality of clinical practice; promotion of evidenced-based; quality-controlled protocols for diagnosis; management; and balance of health promotion and clinical service provision.

Epidemic syphilis in the newly independent states of the former Soviet Union.

Major syphilis epidemics are occurring in the former Soviet Union as a result of the effects of rapid political, economic and social reform on clinical services and sexual behaviour. Together with epidemics of injecting drug use-associated HIV infection, they pose a major threat of large sexually transmitted HIV epidemics. Economic realism demands that control efforts address the market and ideological forces driving the development of interventions, as well as technical aspects of their design.

[The characteristics of the current course and the outcome of pregnancy in syphilis]. / Osobennosti sovremennogo techeniia i iskhod beremennosti pri sifilise.

The authors have analyzed 184 case histories of pregnant women hospitalized at a department for obstetrics and gynecology of hospital No. 52 (134 women) and at the female department for sexually transmitted diseases of the City Center for Skin and Sexually Transmitted Diseases (50 women) in the town of Tashkent in 1980-1988. This analysis has revealed the predominance of latent forms of syphilis in pregnant women; therefore consultation centers for females play the principal role in the detection of syphilis in pregnant women by timely serologic screenings for syphilis. Health-educating activities are inadequate, therefore many women consult a doctor only in the second or even third trimester of pregnancy, and some do not consult a doctor at all. A considerable reduction in the rate of late spontaneous abortions and stillbirths vs. the 'preantibiotic period' of syphilis treatment indicates a relatively benign course of syphilis as far as its fetal effect is concerned. Specific therapy of pregnant syphilis patients with benzylpenicillin procaine salt combined with theonikal essentially reduced the incidence rate of uterine inertia. To prevent intrauterine fetal hypoxia and correct the course of labor sygethin should be administered.

[The rate of detecting Chlamydia in male homosexuals with syphilis]. / Chastota vyiavleniia khlamidii u muzhchin-gomoseksualistov, bol'nykh sifilisom.

A total of 159 homosexuals suffering from various forms of syphilis, aged 17 to 71, were screened for chlamydial antigen with the use of fluorescent monoclonal antibodies. Asymptomatic urogenital chlamydiosis was detected in 33 of 107 (30.8 percent) homosexual syphilitics. In 52 patients the material was collected simultaneously from the throat, urethra, and rectum; Chlamydia were detected in 71.2 percent of these.

[The dynamics of Treponema-specific blood immunoglobulins in early forms of syphilis]. / Dinamika treponemospetsificheskoi immunoglobulinemii pri rannikh formakh sifilisa.

The study has involved 73 patients with syphilis, 31 female and 42 male ones, aged 18-42. Four of these suffered from primary seronegative, 14 from primary seropositive, 21 from secondary fresh, 22 from secondary recurrent, and 12 from early latent seropositive syphilis. Peripheral blood sera were under study. Treponema-specific antibodies of the IgM and IgG classes were titered by enzyme immunoassay. The detected changes in Treponema-specific immunoglobulinemia are in good correlation with clinical staged pattern of syphilis and antiinfectious immunity status.

[Recurrences of gonorrhea in men (the characteristics of the course and treatment)]. / Retsidivy gonorei u muzhchin (osobennosti techeniia i lecheniia).

The examination has involved 218 patients. The incidence of relapses in acute and subacute gonorrhea has made up 6.3%, 5.2% in chronic and 4.5% in complicated condition. Recurrences were observed in 5.3 days on an average after therapy of new gonorrhea cases and in 8.8 days after treatment of chronic disease. Mixed urogenital infection was recorded in 37.8% of cases; in gonorrhea eventuating in clinical cure it was observed in 24% of cases. Relapses developed in 50.2% of patients after antibiotic therapy and in 49.8% after combined treatment. A single relapse occurred in 85.6% of patients; two and more relapses in 14.4%. The disease recurred after penicillin therapy in 6.5% after aminoglycosides in 6.9%, and after tetracyclin treatment in 4.2% of cases. Therapy with proteolytic enzymes (chymotrypsin, trypsin 5 mg i.m. twice a day) combined with antibiotics resulted in etiological cure in 99.3% of patients, the incidence of postgonorrheal symptoms reduced and made up 6.8% (in the patients not administered protease this share made up 19.2%), and the length of inpatient treatment shortened by 8-14.6 days.

[The combination of syphilis and HIV infection]. / Sochetanie sifilisa i VICh-infektsii.

Seven cases of a combined course of syphilis ad HIV infection are described. All the patients are men, homo- and bisexuals. No apparent clinical features of syphilis in these patients were detectable. Recommendations on the strategy of syphilis treatment in patients with HIV infection are given.

[The immune status of homosexuals ill with different forms of syphilis]. / Immunnyi status gomoseksualistov, bol'nykh razlichnymi formami sifilisa.

Status of the cell-mediated, humoral immunity, and nonspecific defense factors were examined before and after specific therapy in 40 homosexuals suffering from secondary relapsing and latent early syphilis. The findings evidence that changes in the cell-mediated immunity of homosexual syphilitics essentially differ from those in heterosexuals with syphilis: decreased count of T-helpers and elevated one of T-suppressors evidence impaired ratio of T-lymphocyte subpopulations and immunoregulatory cell imbalance. A significantly increased level of C4 complement component was observed, evidencing a deficiency of the complement system. These data call for the development of a scheme of immunocorrective therapy for homosexuals suffering from syphilis.

[The immediate results of treating patients with infectious forms of syphilis by the abbreviated single-course reserve method]. / Blizhaishie rezul'taty lecheniia bol'nykh zaraznymi formami sifilisa ukorochennym odnokursovym rezervnym metodom.

The results of rapid single-course oletetrine and tetracycline therapy of early syphilis are analyzed. The time of Treponema pallidum disappearance from syphilid discharge, of syphilid regression, and of the first negative results of the routine serologic tests, immunofluorescence 200/ABC and T. pallidum immobilization tests, as well as the blood serum tetracycline level indicate a high therapeutic efficacy of this method and recommend it for wide use.

[Improved specific and prophylactic treatment methods for pregnant women and the children delivered by mothers infected with syphilis]. / Sovershenstvovanie spetsificheskikh i profilakticheskikh metodov lecheniia beremennykh i detei, rozhdennykh bolevshimi sifilisom materiami.

Uninterrupted methods of specific and prophylactic treatment of pregnant women and children, born from syphilitic mothers, were offered. A new preparation--novocainic salt of benzyl penicillin was used in specific and prophylactic treatment of pregnant women.

[Characteristics of the course of latent forms of syphilis]. / Osobennosti techeniia skrytykh form sifilisa.

Seven patients with latent syphilis are described, in whom the routine serologic tests (RST) were negative during the first examination and over the course of therapy, and the specific tests (T. pallidum immobilization and immunofluorescence) were repeatedly positive before therapy. Early latent seropositive recurrent forms of syphilis were detected in the majority of these patients' sexual partners. The patients were not administered antisyphilis therapy before. The diagnosis of latent seronegative early syphilis negative in the RST is epidemiologically significant, for it helps timely carry out the necessary treatment and prophylaxis measures to prevent the disease dissemination.

[Treatment efficacy in patients with secondary recurrent and latent early syphilis based on a new abbreviated method]. / Effektivnost' lecheniia bol'nykh vtorichnym retsidivnym i skrytym rannim sifilisom po novomu ukorochennomu metodu.

The authors analyze the findings of clinical and serological follow-up of 370 patients with secondary relapsing and early latent syphilis treated with a new rapid method. This method consists in intramuscular injections of water-soluble penicillin in high daily doses (4,000,000, 6,000,000, 8,000,000 U) made for 3-4 weeks. The follow-up period of 1-6 years has confirmed a high therapeutic efficacy of this method.

[A case of active tertiary syphilis]. / Sluchai aktivnogo tretichnogo sifilisa.

A case of tertiary active syphilis in a 41-year-old male patient is described, who had not been administered specific treatment. Clinical symptoms of the disease manifested without apparent provoking factors; they were characterized by extensive involvement and no visceral abnormalities.