Syphilis, Gonorrhea, and Chlamydia Notifications in Galați County, Romania (2017-2025): A Retrospective Surveillance...

Sexually transmitted infections (STIs) are resurgent globally, yet sub-national epidemiological data from Romania remain sparse. This study characterizes long-term STI trends in Galați County (population ~500,000) and examines whether observed morbidity patterns reflect transmission dynamics or surveillance system performance.

Retrospective analysis of all notified STI cases in Galați County, 2017-2025 (nine years; n = 253), from the County Public Health Directorate surveillance database. Data included demographics, clinical stage, detection route, and temporal trends. Quasi-Poisson regression with a population offset estimated the annual change in notification rates; standardized morbidity ratios (SMR) compared local to national levels (2021-2024).

Over nine years, 253 cases were notified: 204 syphilis (80.6%), 49 gonorrhea (19.4%), and no chlamydia. Notification rates declined across 2017-2025 (rate ratio per year = 0.87; 95% CI 0.78-0.97; p = 0.014), reached a trough in 2020 and recovered partially thereafter, a pattern that may reflect variation in case detection, although testing volumes were not available to confirm this. Over 2021-2024, syphilis notification rates exceeded national levels in both males (SMR = 2.35; 95% CI 1.79-3.03; p < 0.0001) and females (SMR = 1.76; 95% CI 1.15-2.57; p = 0.011). Primary-stage disease was recorded in 13 of 204 syphilis cases (6.4%); antenatal screening identified 32 maternal infections over nine years with zero congenital syphilis notifications.

The notification pattern is compatible with an important role of case detection, in particular the contrast between structured antenatal screening and opportunistic detection pathways, but testing and outcome data are needed to confirm this interpretation.