Declining rates of gonorrhoea and syphilis in Strasbourg, France: a 20-year study.

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Abstract
OBJECTIVE--To report the epidemiology of gonorrhoea and syphilis during the years 1973-1992 in the Strasbourg STD clinic and to discuss the data in the light of changes in STD rates in western countries. DESIGN--Retrospective analysis of gonorrhoea and syphilis cases recorded annually, total number of consultations, HIV serology, STD among prostitutes. SETTING--Strasbourg, Bas-Rhin, FRANCE. SUBJECTS--Patients attending the public STD clinic in Strasbourg. RESULTS--From 1973 to 1992 79,786 consultations were recorded. Since 1984, a regular fall has been noted, from more than 4500 consultations a year in the 1970s, to 1519 consultations in 1992. A major decline in gonorrhoea was observed, especially since 1984. There were 457 new cases in 1973 (15.3% of all patients) whereas only seven new cases in 1992 (0.8% of all patients). Syphilis has been declining regularly since 1979, with a reinforcement in this decline since 1984: 168 cases were recorded in 1972 (6.4% of all patients), and only two cases in 1992 (0.2% of all patients). Positive HIV tests were found in 14% and 12% of patients in 1985-86, and the positivity rate has regularly decreased to reach 0.6% in 1992. Prostitutes represented 9.2% of all patients in 1980, and only 0.8% of patients in 1992. Since 1987, syphilis and gonorrhoea have been rarely recorded among prostitutes. CONCLUSIONS--A dramatic decline in both gonorrhoea and syphilis has been observed in Strasbourg, especially since 1984, with a parallel diminution in the STD clinic frequentation. A comparable trend in gonorrhoea rates was noted in many western countries, but syphilis rates are more heterogeneous among geographic areas. Changes in sexual behaviour due to the AIDS epidemic are probably responsible in part for this decline, but nevertheless the rarity of gonorrhoea and syphilis in Strasbourg in 1992 is not clearly explained.