Generic selectors
Exact matches only
Search in title
Search in content
Post Type Selectors
Filter by Categories
15th National Conference of the IAOMFP, Chennai, 2006
Abstracts from current literature
Acne in India: Guidelines for management - IAA Consensus Document
Art & Psychiatry
Association Activities
Association Notes
Award Article
Book Review
Brief Report
Case Analysis
Case Letter
Case Letters
Case Notes
Case Report
Case Reports
Clinical and Laboratory Investigations
Clinical Article
Clinical Studies
Clinical Study
Conference Oration
Conference Summary
Continuing Medical Education
Cosmetic Dermatology
Current Best Evidence
Current Issue
Current View
Derma Quest
Dermato Surgery
Dermatosurgery Specials
Dispensing Pearl
Do you know?
Drug Dialogues
Editor Speaks
Editorial Remarks
Editorial Report
Editorial Report - 2007
Editorial report for 2004-2005
Fourth All India Conference Programme
From Our Book Shelf
From the Desk of Chief Editor
Get Set for Net
Get set for the net
Guest Article
Guest Editorial
How I Manage?
IADVL Announcement
IADVL Announcements
IJDVL Awards
IJDVL Awards 2018
IJDVL Awards 2019
IJDVL Awards 2020
IJDVL International Awards 2018
Images in Clinical Practice
In Memorium
Inaugural Address
Knowledge From World Contemporaries
Leprosy Section
Letter in Response to Previous Publication
Letter to Editor
Letter to the Editor
Letter to the Editor - Case Letter
Letter to the Editor - Letter in Response to Published Article
Letter to the Editor - Observation Letter
Letter to the Editor - Study Letter
Letter to the Editor - Therapy Letter
Letter to the Editor: Articles in Response to Previously Published Articles
Letters in Response to Previous Publication
Letters to the Editor
Letters to the Editor - Letter in Response to Previously Published Articles
Letters to the Editor: Case Letters
Letters to the Editor: Letters in Response to Previously Published Articles
Medicolegal Window
Miscellaneous Letter
Net Case
Net case report
Net Image
Net Letter
Net Quiz
Net Study
New Preparations
News & Views
Observation Letter
Observation Letters
Original Article
Original Contributions
Pattern of Skin Diseases
Pediatric Dermatology
Pediatric Rounds
Presedential Address
Presidential Address
Presidents Remarks
Report of chief editor
Report of Hon : Treasurer IADVL
Report of Hon. General Secretary IADVL
Research Methdology
Research Methodology
Resident page
Resident's Page
Resident’s Page
Residents' Corner
Residents' Corner
Residents' Page
Review Article
Review Articles
Reviewers 2022
Revision Corner
Self Assessment Programme
Seminar: Chronic Arsenicosis in India
Seminar: HIV Infection
Short Communication
Short Communications
Short Report
Special Article
Specialty Interface
Study Letter
Study Letters
Symposium - Contact Dermatitis
Symposium - Lasers
Symposium - Pediatric Dermatoses
Symposium - Psoriasis
Symposium - Vesicobullous Disorders
Symposium Aesthetic Surgery
Symposium Dermatopathology
Symposium-Hair Disorders
Symposium-Nails Part I
Symposium-Nails-Part II
Systematic Review and Meta-Analysis
Systematic Reviews and Meta-analyses
Systematic Reviews and Meta-analysis
Therapeutic Guideline-IADVL
Therapeutic Guidelines
Therapeutic Guidelines - IADVL
Therapy Letter
Therapy Letters
View Point
What’s new in Dermatology
View/Download PDF

Translate this page into:

Net Letter
88 (
); 702-702

Is COVID-19 affecting the epidemiology of syphilis in Belgrade?

Department of Counselling for Sexually Transmitted Infections, City Institute for Skin and Venereal Disease, Dzordza Vasingtona 17, Belgrade, Serbia
Institute of Epidemiology, Faculty of Medicine, University of Belgrade, Belgrade, Serbia
Corresponding author: Prof Hristina D Vlajinac, Institute of Epidemiology, Faculty of Medicine, University of Belgrade, Belgrade, Serbia.
This is an open-access article distributed under the terms of the Creative Commons Attribution-Non Commercial-Share Alike 4.0 License, which allows others to remix, transform, and build upon the work non-commercially, as long as the author is credited and the new creations are licensed under the identical terms.

How to cite this article: Bjekic MD, Vlajinac HD. Is COVID-19 affecting the epidemiology of syphilis in Belgrade? Indian J Dermatol Venereol Leprol 2022;88:702-702.


The first case of coronavirus 2019 disease (COVID-19) in Serbia was reported on 6th March 2020, with the Serbian government declaring a state of emergency and nationwide lockdown on 15 March 2020.1 This included various social distancing measures, some of which still remain after the lockdown was lifted on 6th May 2020. Although the City Institute for Skin and Venereal Diseases in Belgrade is a reference centre for sexually transmitted diseases, during the lockdown it remained open only for emergencies. Late June and November saw the reinstatement of even stricter social confinement measures, as two new waves of infection broke out. This study aims to assess whether COVID-19 affected the epidemiology of syphilis in Belgrade. We used data on newly registered cases of syphilis diagnosed at any stage of the disease during the study period of three years - 2018, 2019 and 2020. Data collected included age, gender, sexual orientation, human immunodeficiency virus (HIV) status and stage of syphilis. Chi-square test and t-test were used in statistical analysis. The investigation was approved by the Ethical Committee of the City Institute for Skin and Venereal Diseases.

Between 2018 and 2020, 314 new cases of syphilis were diagnosed in the City Institute for Skin and Venereal Diseases in Belgrade comprising 100 cases in 2018, 89 cases in 2019 and 125 in 2020 [Table 1]. In comparison with 2018 and 2019, patients with syphilis diagnosed in 2020 did not significantly differ in their median age, male/female ratio, sexual orientation, HIV status and stage of the disease. The mean age of patients in 2020 was significantly lower compared to the mean age of patients in both 2018 and 2019 (P < 0.05) [Table 1]. In fact, the comparison of age-groups of patients in the observed years showed that in 2020, number of patients of the age of 50 years or more was less when compared to 2018 and 2019 (P = 0.011 and P = 0.047, respectively).

Table 1:: Demographic characteristics of new syphilis cases diagnosed in the City Institute for Skin and Venereal Diseases, Belgrade, in 2018, 2019 and 2020
Year 2018 2019 2020
Number of cases 100 89 125
Mean age ± SD 38.6 ± 12.7 37.6 ± 11.4 34.7 ± 9.9*
Median age 36 36 34
Gender: Male
97 (97.0%)
3 (3.0%)
84 (94.4%)
5 (5.6%)
121 (96.7%)
4 (3.3%)
Sexual orientation:
79 (79.0%)
21 (21.0%)
67 (75.3%)
22 (24.7%)
102 (81.6%)
23 (18.4%)
HIV positive 7 (7.0%) 11 (16.8%) 13 (10.4%)
Primary syphilis 29 (29.0%) 21 (23.6%) 32 (25.6%)
Secondary syphilis 33 (33.0%) 38 (42.7%) 42 (33.6%)
Recent latent syphilis 30 (30.0%) 25 (20.0%) 35 (28.0%)
Late latent syphilis 8 (8.0%) 5 (5.7%) 16 (12.8%)
According to t-test, P = 0.011 in comparison to 2018, and P = 0.047 in comparison to 2019; SD - standard deviation; HIV - human immunodeficiency virus

During the period from 2009 to 2018, the number of newly diagnosed syphilis cases in Belgrade was increasing and the highest crude rate was recorded in 2018.2 Compared to 2018 and 2019, the number of syphilis cases increased in 2020 by 25% and 40.5%, respectively. The actual number of new syphilis cases in 2020 is probably even higher because people had limited access to the public health service and some infected persons might have sought care in the private sector.

Our results are in line with data from Bologna where the percentage of new syphilis cases and other sexually transmitted infections had significantly increased3 suggesting that the lockdown had not actually interfered with high-risk sexual behaviour. Reports from some European cities have shown that the incidence of sexually transmitted infections decreased during the lockdown,4,5 which could be explained by restricted movement or reduced access to health services for people with sexually transmitted infections. However, Sacchelli et al.6 reported in their study that no significant change in the incidence of sexually transmitted infections has occurred during the pandemic.

The expected decrease in the number of newly diagnosed syphilis cases in Belgrade, due to the pandemic induced restrictive measures, did not probably occur because during the last 10 years, in our population syphilis has predominantly been diagnosed in men who have sex with men2 who can easily reach sexual partners through mobile dating applications and do not require public places to meet.

Compared to the previous two years, the lower number of syphilis cases in those with age 50 years or more in 2020 could be explained by the fact that older people due to fear of COVID-19, have shown greater responsibility towards their own health and limited their social contacts with household members only (people over 65 were completely forbidden to go out during the lockdown) thereby reducing their chance to come into potential sexual contact.

Stress, anxiety, depression and isolation caused by the pandemic has certainly affected the sexual behaviour, changing sexual habits and caused more frequent visits to porn sites, sex toys and cybersex consumption.7 A study conducted in Israel8 has shown that men who have sex with men limited kissing their sexual partners and increased the use of sex phones, webcam sex and porn consumption during lockdown. The majority of our patients with syphilis had unprotected sex during the lockdown and explained that sex was a way to relieve frustration due to the pandemic and that they participated in private gay orgies. In conclusion, the increased number of new syphilis cases in our institute indicates that the pandemic did not significantly affect the risky behaviour of the majority of the population, with the exception of those who were 50 and more years old.

Declaration of patient consent

Patients’ consent is not required as patients’ identity is not disclosed or compromised.

Financial support and sponsorship


Conflicts of interest

There are no conflicts of interest.


  1. State of emergency declared throughout Serbia. . Available from: [Accessed on January 16, 2020]
    [Google Scholar]
  2. , , . Syphilis characteristics in Belgrade population in period from 2009 to 2018. Health Care. 2020;49:9-14.
    [CrossRef] [Google Scholar]
  3. , , , , , . STIs and the COVID-19 pandemic: The lockdown does not stop sexual infections. J Eur Acad Dermatol Venereol. 2020;34:e766-8.
    [CrossRef] [PubMed] [Google Scholar]
  4. , , , , . Social distancing to combat COVID-19 led to a marked decrease in food-borne infections and sexually transmitted diseases in Spain. J Travel Med. 2020;27:134. taaa
    [CrossRef] [PubMed] [Google Scholar]
  5. , , , , , . Is COVID-19 affecting the epidemiology of STIs? The experience of syphilis in Rome [published online ahead of print, 2020 Jul 27] Sex Transm Infect. 2021;91:78.
    [CrossRef] [PubMed] [Google Scholar]
  6. , , , , , , et al. Sexually transmitted infections during 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. J Eur Acad Dermatol Venereol. 2020;34:e553-6.
    [CrossRef] [PubMed] [Google Scholar]
  7. , , . Analyses the effects of COVID-19 outbreak on human sexual behaviour using ordinary least-squares based multivariate logistic regression [published online ahead of print, 2020 Oct 18] 20201-21.
    [CrossRef] [PubMed] [Google Scholar]
  8. , . COVID-19 and the changes in the sexual behaviour of men who have sex with men: Results of an online survey. J Sex Med. 2020;17:1827-34.
    [CrossRef] [PubMed] [Google Scholar]

Fulltext Views

PDF downloads
View/Download PDF
Download Citations
Show Sections