key: cord-0745612-1vphx4mn authors: Evangelou, K.; Rozani, S.; Pafiti, M.; Syrigos, N. title: Syphilis transmission: exacerbated due to the COVID-19 pandemic? date: 2022-04-28 journal: Ethics Med Public Health DOI: 10.1016/j.jemep.2022.100782 sha: 53acc4134c9eac96eff693236533c0a52553a085 doc_id: 745612 cord_uid: 1vphx4mn nan We read a recently published article entitled "The Epidemic of Sexually Transmitted Diseases Under the Influence of Covid-19 in China" and were pleased by the reports of significant decline in STD cases during the Covid-19 pandemic in China. According to the Bureau for Disease Control and Prevention of China National Health Commission, actual syphilis case numbers were less than half of those predicted in February 2020 and were lower in mid-pandemic, compared to pre-pandemic thresholds [1] . While the article reviews similar declines in syphilis incidence worldwide, we hesitate to be complacent as supplementary data collected from PubMed indicate a contrary infection exacerbation in various locations around the world. On this basis, it is acknowledged that the introduction of novel and effective prevention measures is necessary for effective transmission restraint. Syphilis is a disease that is primarily transmitted sexually; it is far more prevalent in individuals who engage in unprotected sexual intercourse and/or have multiple partners, HIVpositive and men having sex with men, though it can also be transmitted non-sexually (e.g., placental circulation) [2] . Although social restrictions enforced during the pandemic had allegedly limited sexual partner contacts (fewer entertainment venue and bar gatherings, public transportation confinement and mandatory stay-at-home policies) [1] , and it would have been resultantly expected to observe a remarkable universal decline in STD incidence, data collected from various countries and summarized in (Table I) Governments should reinforce sexual partner tracing, early notification, and treatment systems, for patient reinfection prevention and exposed patient care provision. Adhesion to official preventive guidelines and appropriate education are advised, including proper condom use especially among MSM, understanding the need for screening, recognising early manifestation sings (e.g., rashes, chancre), treating ulcers prior to laboratory confirmation and assessing individual epidemiological risk status. Organizing campaigns providing mental support to the public during isolation periods would be helpful, to avoid sexual activity flareups following restriction removal. Free pharmacological care for infected or possibly infected individuals is essential for early treatment and interruption of the bacterial transmission chain. Lastly but most importantly, STD monitoring and surveillance systems should reclaim their former priority; syphilis programmatic functions and case reporting have diminished as of Covid-19 being prioritized, so testing and medical attention towards infected individuals must be preserved at pre-pandemic levels. Covid-19 pandemic afflicting STD surveillance is an indisputable fact. What has emerged, however, is a phenomenal increase in syphilis transmission among patients, mentally and socially stricken by unprecedented lifestyle changes. Medical communities owe to spread awareness about infection outbreaks in various parts around the world and all necessary measures be enforced to prevent further syphilis transmission, that has been deservedly described as a "modern epidemic" [10] . The epidemic of sexually transmitted diseases under the influence of Covid-19 in China StatPearls. Treasure Island (FL): StatPearls Publishing The impact of the Covid-19 pandemic on sexually transmitted infections services -experience from Bialystok, Poland Epidemiology of reported HIV and other sexually transmitted infections during the Covid-19 Sexually transmitted infections during the Covid-19 outbreak: comparison of patients referring to the service of sexually transmitted diseases during the sanitary emergency with those referring during the common practice Sexually transmitted diseases during the Covid-19 pandemic: A focus on syphilis and gonorrhoea in Cuba Increase of early syphilis cases during the Covid-19 pandemic in the Czech Republic affecting the epidemiology of STIs? The experience of syphilis in Rome Syphilis and the Covid-19 pandemic: Did the lockdown stop risky sexual behavior? The modern epidemic of syphilis Acknowledgement: Not applicable. The authors declare no conflicts of interest with regard to this article.