Review of Current Evidence and Comparison of Guidelines for ...

EUR/03/5045931
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Annex 5
AKOVBIAN V, FILATOVA E. MANAGEMENT OF SYPHILIS INFECTED PATIENTS IN RUSSIA.
COUNTRY BACKGROUND PAPER, MAY 2002. (ORIGINAL IN RUSSIAN;
TRANSLATED IN ENGLISH)
Management of Syphilis Infected Patients in Russia (English translation)
Vagan Akovbian Phd, MD
Ekaterina Filatova, Phd
Background
The system of the STI control in the former USSR including the responsibility of a patient in
base of the article 115 of the USSR Criminal Code, medical staff’s duties, treatment schemes,
and the order of further observation of a patient within the following five years was strictly
regulated (Instructions given by USSR Health Ministry methodical recommendations).
Methodical Guidelines were distributed through DVS clinics only and were inaccessible for
other specialists. Before the 1976 syphilis treatment was conducted only in inpatient clinics. A
syphilis positive patient was to be hospitalized within 24 hours after having received the positive
test.
Since 1976 outpatient treatment prescription has become allowed for people who had registration
at the place of living (propiska) and job. By the government’s opinion this allowed people to
continue their treatment up to the end. If a person declined from syphilis treatment he was to be
punished by law. According to article 115 of the Soviet Criminal Code these persons were
subjected to one year imprisonment, where they got suitable treatment. In the 1980s about 1000
people per year were condemned for this reason (1).
Nowadays some of syphilis infected people (pregnant women, children, elderly people and
people with other diseases) get treatment in DVS stationary clinics. People related with
behavioural risk: homeless, sex workers, criminals, etc. go through compulsory treatment in
closed guarded inpatient clinics. Usually 20% of all of notified syphilis people get stationary
treatment.
The evolution of national “Syphilis treatment and prevention instructions” from 1932 to
2002
The document describing ways of syphilis treatment, obligatory for application in the former
USSR and Russian Federation, was called “Methodical Guidelines” or “Methodical
instructions”. It was issued every 5–7 years. During the last 70 years about 20 similar documents
totally have been published. The main ones are presented in Table 1.
The Central DVS Institute develops new methods of syphilis and other STI treatment, releasing
the instructions confirmed by the Health Department. In the time of the USSR new antibiotics
were sent to some leading scientific centres and clinics (Dermatovenereology Institutes, high