Gone viral: Why sexually transmitted infections are rising sharply in Europe

Bulgaria has recorded the highest number of congenital syphilis cases. The infection is concentrated primarily within the Roma community. Although Roma account for only 4% of the population, they represented 35% of all syphilis cases identified in the study. More than half of those infected (55%) were women, and 14% of them were pregnant.

This is a population with limited access to healthcare, a high degree of social exclusion, and chronic distrust of state institutions. As a result, prenatal screening programs that could interrupt vertical transmission often fail to reach them.

A similar pattern can be observed in the Netherlands among migrant women working in the sex industry. Researchers at the Dutch Ministry of Health have documented substantially higher rates of syphilis in this group than among Dutch-born women. At the same time, they are far less likely to return for follow-up care. In other words, infections are detected but not systematically monitored, leaving treatment outcomes unknown.

The situation in Portugal is particularly troubling. The country has one of the highest national rates of congenital syphilis in Europe — 17.5 cases per 100,000 live births. This far exceeds the World Health Organization's elimination target, which requires a rate of no more than one case per 100,000 live births. To prevent mother-to-child transmission as effectively as possible, the WHO calls for syphilis testing coverage among pregnant women to exceed 95%. Portugal falls short of this target, with coverage gaps of around 50% among vulnerable population groups.

Women from marginalized communities, migrant women (the ECDC report notes that more than half of pregnant women diagnosed with syphilis in Portugal were born outside the country), and low-income women often do not receive prenatal care early in pregnancy and lack access to treatment.

Another almost entirely invisible group is victims of human trafficking. By definition, no comprehensive European data exist for this population: these are people who are being deliberately hidden from institutions, including healthcare systems. The limited studies available in the literature report STI rates among trafficking victims that are between 22 and 111 times higher than those observed in the general population. However, since this group falls outside registries and screening programs, its contribution to overall disease trends cannot be reliably estimated.