Review of Current Evidence and Comparison of Guidelines for ...
Review of Current Evidence and Comparison of Guidelines for ...
Review of Current Evidence and Comparison of Guidelines for ...
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EUR/03/5045931<br />
page 32<br />
Annex 5<br />
AKOVBIAN V, FILATOVA E. MANAGEMENT OF SYPHILIS INFECTED PATIENTS IN RUSSIA.<br />
COUNTRY BACKGROUND PAPER, MAY 2002. (ORIGINAL IN RUSSIAN;<br />
TRANSLATED IN ENGLISH)<br />
Management <strong>of</strong> Syphilis Infected Patients in Russia (English translation)<br />
Vagan Akovbian Phd, MD<br />
Ekaterina Filatova, Phd<br />
Background<br />
The system <strong>of</strong> the STI control in the <strong>for</strong>mer USSR including the responsibility <strong>of</strong> a patient in<br />
base <strong>of</strong> the article 115 <strong>of</strong> the USSR Criminal Code, medical staff’s duties, treatment schemes,<br />
<strong>and</strong> the order <strong>of</strong> further observation <strong>of</strong> a patient within the following five years was strictly<br />
regulated (Instructions given by USSR Health Ministry methodical recommendations).<br />
Methodical <strong>Guidelines</strong> were distributed through DVS clinics only <strong>and</strong> were inaccessible <strong>for</strong><br />
other specialists. Be<strong>for</strong>e the 1976 syphilis treatment was conducted only in inpatient clinics. A<br />
syphilis positive patient was to be hospitalized within 24 hours after having received the positive<br />
test.<br />
Since 1976 outpatient treatment prescription has become allowed <strong>for</strong> people who had registration<br />
at the place <strong>of</strong> living (propiska) <strong>and</strong> job. By the government’s opinion this allowed people to<br />
continue their treatment up to the end. If a person declined from syphilis treatment he was to be<br />
punished by law. According to article 115 <strong>of</strong> the Soviet Criminal Code these persons were<br />
subjected to one year imprisonment, where they got suitable treatment. In the 1980s about 1000<br />
people per year were condemned <strong>for</strong> this reason (1).<br />
Nowadays some <strong>of</strong> syphilis infected people (pregnant women, children, elderly people <strong>and</strong><br />
people with other diseases) get treatment in DVS stationary clinics. People related with<br />
behavioural risk: homeless, sex workers, criminals, etc. go through compulsory treatment in<br />
closed guarded inpatient clinics. Usually 20% <strong>of</strong> all <strong>of</strong> notified syphilis people get stationary<br />
treatment.<br />
The evolution <strong>of</strong> national “Syphilis treatment <strong>and</strong> prevention instructions” from 1932 to<br />
2002<br />
The document describing ways <strong>of</strong> syphilis treatment, obligatory <strong>for</strong> application in the <strong>for</strong>mer<br />
USSR <strong>and</strong> Russian Federation, was called “Methodical <strong>Guidelines</strong>” or “Methodical<br />
instructions”. It was issued every 5–7 years. During the last 70 years about 20 similar documents<br />
totally have been published. The main ones are presented in Table 1.<br />
The Central DVS Institute develops new methods <strong>of</strong> syphilis <strong>and</strong> other STI treatment, releasing<br />
the instructions confirmed by the Health Department. In the time <strong>of</strong> the USSR new antibiotics<br />
were sent to some leading scientific centres <strong>and</strong> clinics (Dermatovenereology Institutes, high