• Milan Bjekić City Institute for Skin and Venereal Diseases, Džordža Vašingtona 17, 11000 Belgrade
  • Vlajinac Hristina Institute of Epidemiology, Faculty of Medicine, University of Belgrade
  • Ivana Dunić City Institute for Skin and Venereal Diseases, Belgrade
Keywords: syphilis, gonorrhoea, men who have sex with men, HIV


Intoduction/Aim: Although syphilis and gonorrhoea are “old” sexually transmitted diseases they have become a “new” problem: syphilis resurgence is noticed worldwide and it is followed by HIV co-infection, while drug-resistant gonorrhoea could be potentially untreatable infection. The aim of this study was to identify any differences between syphilis and gonorrhoea cases in regard to their demographic characteristics and behaviour.
Methods: In this cross-sectional study, data were collected from consecutive syphilis and gonorrhoea cases registered at the City Institute for Skin and Venereal Diseases in Belgrade in 2016.
Results: The study included 278 cases, 140 (50.4%) with gonorrhoea and 138 (49.6%) with syphilis. In comparison with gonorrhoea patients, syphilis patients were older, more frequently males with higher education, had their first sexual intercourse later, at 20+ years of age, less frequently had a permanent sexual partner, were more frequently homosexual or bisexual, and during the last 6 months had more frequently anal sex and oral-anal sex, as well as sex with a foreigner. They also had gonorrhoea in their personal history less frequently, but more frequently syphilis and hepatitis B infection, and they were more frequently HIV positive.
Conclusion: In comparison with gonorrhoea cases, patients with syphilis were more frequently men who have sex with men with more pronounced risk behaviour and HIV co-infection.


Newman L, Rowley J, Vander Hoorn S, Wijesooriya NS, Unemo M, Low N, et al. Global estimates of the prevalence and incidence of four curable sexually transmitted infections in 2012 based on systematic review and global reporting. PLoS One 2015; 10(12): e0143304.

Centre for Disease Control and Prevention: Report of infectious diseases in Belgrade in 2016. Belgrade: City Institute of Public Health of Belgrade, 2017.

Garnett GP, Aral SO, Hoyle DV, Cates W, Anderson RM. The natural history of syphilis. implications for the transmission dynamics and control of infection. Sex Transm Dis 1997; 24(4): 185-200.

Hook EW III, Handsfield HH. Gonococcal infections in the adult. In: Holmes KK, Sparling PF, Mardh P, Stamm WE, eds. Sexually Transmitted Diseases. 4th ed. New York: McGraw Hill, 2008.

Sanchez MR. Syphilis. In: Freedberg IM, Eisen AZ, Wolff K, Austen KF, Goldsmith LA, Katz SI, eds. Fitzpatrick’s dermatology in general medicine, 6th ed. New York: McGraw-Hill, 2003.

Lynn WA, Lightman S. Syphilis and HIV: a dangerous combination. Lancet Infect Dis 2004; 4(7):456-466.

Centers for Disease Control and Prevention (CDC). STD Surveillance case definitions. Available at: http://www.cdc.gov/std/stats/casedefinitions-2014. pdf

Centers for Disease Control and Prevention (CDC). Recent changes to gonorrhea and syphilis case definitions: program impact. Available at: http:/www.cdc.gov/std/stats/casedef-programimpact-2014.pdf

Willeford WG, Bachmann LH. Syphilis ascendant: a brief history and modern trends. Trop Dis Travel Med Vaccines 2016; 2:20.

Alirol E, Wi Te, Bala M, Bazzo ML, Chen XS, Deal C, et al. Multidrug-resistant gonorrhea: a research and development roadmap to discover new medicines. PLoS Med 2017; 14(7): e1002366.

Galvis SR, Cohen MS. The role of sexually transmitted diseases in HIV transmission. Nat Rev Microbiol 2004; 2(1):33-42.

Zetola NM, Bernstein KT, Wong E, Louie B, Klausner JD. Exploring the relationship between sexually transmitted diseases and HIV acquisition by using different study designs. J Acquir Immune Defic Syndr 2009; 50(5):546-551.

Bernstein KT, Marcus JL, Nieri G, Philip SS, Klausner JD. Rectal gonorrhea and chlamydia reinfection is associated with increased risk of HIV seroconversion. J Acquir Immune Defic Syndr 2010; 53(4):537-543.

Nguyen VK, Greenwald ZR, Trottier H, Cadieux M,Goyette A, Beauchemin M, et al. Incidence of sexually transmitted infections before and after preexposure prophylaxis for HIV. AIDS 2018; 32(4):523-530.

Paz-Bailey G, Meyers A, Blank S, Brown J, Rubin S, Braxton J, et al. A case-control study of syphilis among men who have sex with men in New York City: association with HIV infection. Sex Transm Dis 2004; 31(10): 581-587.

Wong W, Chew J, Kent C, Klausner J. Risk factors for early syphilis among gay and bisexual men seen in an STD Clinic: San Francisco, 2002-2003. Sex Transm Dis 2005: 32(7): 458-463.

Purcell DW, Johnson C, Lansay A, Prejean J, Stein R, Denning P, et al. Calculating disease rates for risk groups: estimating the national population size of men who have sex with men (abstract). National STD Prevention Conference. Atlanta, Georgia: CDC; 2010.

Spicknall IH, Gift TL, Bernstein KT, Aral SO. Sexual networks and infection transmission networks among men who have sex with men as causes of disparity and targets of prevention. Sex Transm Infect 2017; 93(5): 307-308.

Chandra A, Mosher WD, Copen C, Sionean C. Sexual behavior, sexual attraction, and sexual identity in the United States: Data from the 2006-2008 National Survey of Family Growth. Natl Health Stat Report 2011; 36: 1-36.

Bjekić M, Šipetić-Grujičić S, Vlajinac H, Nikolic A. Oral sex related knowledge and oral sex behavior among homosexual and heterosexual men in Belgrade: a cross-sectional study. Indian J Dermatol Venereol Leprol 2018; 84(5): 563-568.

Bjekić M, Šipetić-Grujičić S, Begović-Vuksanović B, Rafailović N, Vlajinac H. Syphilis resurgence in Belgrade, Serbia in the new millennium: an outbreak in 2014. Centr Eur J Public Health 2017: 25(4): 277-281.

Communicable Disease Surveillance Centre. Increased transmission of syphilis in Brighton and Greater Manchester among men who have sex with men. Commun Dis Rep CDR Wkly 2000; 10: 383-386.

Barry PM, Kent CK, Klausner JD. Risk factors for gonorrhea among heterosexuals – San Francisco, 2006. Sex Transm Dis 2009;36 (2 Suppl): S62-6.

Bjekić M, Vlajinac H, Šipetić S, Marinković J. Risk factors for gonorrhoea: case – control study. Genitourin Med 1997; 73(6):518- 521.

Kirkcaldy RD, Zaidi A, Hook EW 3rd, Holmes KK, Soge O, del Rio C, et al. Neisseria gonorrhoeae antimicrobial resistance among men who have sex with men and men who have sex exclusively with women: The Gonococcal Isolate Surveillance Project, 2005–2010 Ann Intern Med 2013; 158: 321-328.

How to Cite
Bjekić, M., Hristina, V., & Dunić , I. (2019). DIFFERENCE IN SEXUAL BEHAVIOUR BETWEEN SYPHILIS AND GONORRHOEA CASES, BELGRADE. Health Care, 48(4), 15-24. https://doi.org/10.5937/ZZ1904015B
Original paper