Kristian Kofoed and Helle Kiellberg Larsen – Controversies and challenges in Venerology in Denmark
the Nordic countries . In 1995 , only 15 cases of syphilis were reported in Denmark . However , in the past 20 years , a 50-fold increase , to 777 cases in 2015 , has been observed ( 4 ). The majority of those infected are men who have sex with men ( 5 ). However , in recent years there has been a considerable increase among heterosexual men and women , and it seems that syphilis is being reintroduced in both sexes . Approximately one-third of infected men are HIV-positive . HIV and syphilis are a bad combination , as each can facilitate infection by the other ( 5 ).
Penicillin remains the drug of choice to treat syphilis , and even though it has been used to treat the disease for many decades , we still have no issues with resistance to penicillin .
Gonorrhea
In contrast to syphilis , gonorrhoea has progressively developed resistance to the antibiotics prescribed to treat it . Following the spread of gonococcal fluoroquinolone resistance , the cephalosporin antibiotics have been the foundation of recommended treatment for gonorrhoea . The emergence of cephalosporin-resistant gonorrhoea would significantly complicate the ability of providers to treat gonorrhoea successfully , since we have few antibiotic options left that are simple , well-studied , well-tolerated and highly effective . Thus , it is disturbing that treatment failure to third-generation cephalosporin has been confirmed in Norway and Sweden ( 6 , 7 ). To our knowledge , so far , no cases have been reported in the other Nordic countries .
Since 2011 there has been an increase in Denmark in the number of cases of gonorrhoea , especially among heterosexuals . In 2015 , 2,735 cases were reported , compared with only 492 in 2011 ( 8 ) ( Fig . 1 ). Even though some of the increase may be due to change in the reporting system , the number is alarming . In 2015 the recommended treatment in Denmark was changed to intramuscular ceftriaxone , 500 mg , in combination with oral azithromycin , 2 g . Denmark never introduced cefixime as a treatment option . It is worth mentioning that , among the cases of gonorrhoea from 2015 , 26 % of cases had a negative culture and were only detected by the nucleic acid amplification test ( NAAT ) ( 8 ).
To conclude , we need to focus on the venereology part of our specialty , as the demand for our expertise is growing rapidly !
References
1 . Lorincz AT , Reid R , Jenson AB , Greenberg MD , Lancaster W , Kurman RJ . Human papillomavirus infection of the cervix : relative risk associations of 15 common anogenital types . Obstet Gynecol 1992 ; 79 : 328 – 337 .
2 . Sandø N , Kofoed K , Zachariae C , Fouchard J . A reduced national incidence of anogenital warts in young Danish men and women after introduction of a national quadrivalent human papillomavirus vaccination programme for young women — an ecological study . Acta Derm Venereol 2014 ; 94 : 288 – 292 .
3 . Knell RJ . Syphilis in renaissance Europe : rapid evolution of an introduced sexually transmitted disease ? Proc Biol Sci 2004 ; 271 Suppl 4 : S174 – S176 . 4 . Cowen S , Hofmann S . Syphilis 2015 . Epi-Nyt 2016 ; Uge 36 . 5 . Kofoed K , Gerstoft J , Mathiesen LR , Benfield T . Syphilis and human immunodeficiency virus ( HIV ) -1 coinfection : influence on CD4 T-cell count , HIV-1 viral load , and treatment response . Sex Transm Dis 2006 ; 33 : 143 – 148 .
6 . Unemo M , Golparian D , Syversen G , Vestrheim DF , Moi H . Two cases of verified clinical failures using internationally recommended first-line cefixime for gonorrhoea treatment , Norway , 2010 . Euro Surveill 2010 ; 15 ( 47 ).
7 . Golparian D , Ohlsson A , Janson H , Lidbrink P , Richtner T , Ekelund O , et al . Four treatment failures of pharyngeal gonorrhoea with ceftriaxone ( 500 mg ) or cefotaxime ( 500 mg ), Sweden , 2013 and 2014 . Euro Surveill . 2014 ; 19 ( 30 ).
8 . Cowan S , Espenhain L , Hoffmann S . Gonorré 2015 . Epi-Nyt 2016 ; Uge 38 .
9 . Cowan S , Christiansen AH , Hoffmann S . Gonoré 2014 . Epi-Nyt
2015 ; Uge 40 . 10 . Cowan S , Hoffmann S . Gonoré 2013 . Epi-Nyt 2014 ; Uge 35 . 11 . Søborg B , Cowan S , Jensen JS . Gonoré 2012 . Epi-Nyt 2013 ; Uge 35 . 12 . Søborg B , Cowan S , Hoffmann S . Gonoré 2011 . Epi-Nyt 2012 ;
Uge 36 .
3000
2011 2012 2013 2014 2015
2500
2000
1500
1000
500
0 Total DK Men DK Women DK Total BBH Men BBH Women BBH
Fig . 1 . Number of cases of gonorrhoea in Denmark ( DK ) and the Venereal Clinic Bispebjerg Hospital ( BBH ) 2011 – 2015 ( missing data from 2011 and 2014 BBH ) ( 8 – 12 ). Since 2014 , data has been extracted from the Danish Microbiology Database ( MiBa ) ( 8 ).
88 Dermato-Venereology in the Nordic Countries
Forum for Nord Derm Ven 2016 , Vol . 21 , No . 4