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BJID 597 15
INFECTIOUS DISEASES
www.elsevier.com/locate/bjid
Original article
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a r t i c l e
i n f o
a b s t r a c t
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Article history:
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Aim: The purpose of the study was to investigate frequency and characteristics of gonorrhea
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Methods: Data from the City Institute for Skin and Venereal Diseases to which all gonorrhea
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Keywords:
Background: The Roma ethnic group is the largest and most marginalized minority in Europe,
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Roma population
Results: During the period of 20102014 sexually transmitted infections were more frequent
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Syphilis
among Roma than in rest of Belgrade population. Average percentages of Roma among all
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Gonorrhea
reported subjects with syphilis and those with gonorrhea were 9.6% and 13.5%, respectively,
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Serbia
while the percentage of Roma in the total Belgrade population was about 1.6%. Roma with
syphilis and gonorrhea were more frequently men (75%), most frequently aged 2029 years
(43.4%), never married (64.5%), with elementary school or less (59.2%), unemployed (80.3%),
and heterosexual (89.5%). Among Roma 10.5% were sex workers and 68.4% did not know
the source of their infection. Signicant differences between Roma cases and other cases in
Belgrade in all characteristics observed were in agreement with differences between Roma
population and the total population of Serbia.
Conclusion: The present study conrmed the vulnerability of the Roma population to sexually
transmitted infections.
2016 Elsevier Editora Ltda. This is an open access article under the CC BY-NC-ND
license (http://creativecommons.org/licenses/by-nc-nd/4.0/).
Introduction
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According to the population census in 2011 the total number of declared Roma in Serbia was 147,604 which accounts for
2.05% of the population in Serbia. The highest concentration
of declared Roma in Serbia is in Belgrade, the capital and the
largest city, where there are 27,325 or 18.5% of their total number, and 1.6% of the total population of Belgrade.2 The Roma
minority is the most vulnerable and marginalized in the eld
Corresponding author.
E-mail address: kristiv@eunet.rs (H. Vlajinac).
http://dx.doi.org/10.1016/j.bjid.2016.05.004
1413-8670/ 2016 Elsevier Editora Ltda. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/
licenses/by-nc-nd/4.0/).
Please cite this article in press as: Bjekic M, et al. Characteristics of gonorrhea and syphilis cases among the Roma ethnic group in Belgrade,
BJID 597 15
Serbia. Braz J Infect Dis. 2016. http://dx.doi.org/10.1016/j.bjid.2016.05.004
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Results
The frequency of syphilis and gonorrhea among Roma and
other ethnic groups of Belgrade population taken together are
presented in Table 1. During the period of 20102014 the Roma
accounted for 3.4% to 17.1% (an average of 9.6%) out of all
subjects registered with syphilis and for 11.7% to 18.8% (an
average of 13.5%) out of all registered patients with gonorrhea. Considering that the percentage of Roma in the total
Belgrade population was about 1.6%, both syphilis and gonorrhea were more frequent among Roma comparing with the
rest of Belgrade population.
Roma with syphilis and gonorrhea were more frequently
men (75%), the majority aged 2029 years (43.4%), never
married (64.5%), with elementary school or less (59.2%), unemployed (80.3%), and heterosexual (89.5%). Among them 10.5%
were sex workers and 68.4% did not know the source of their
Methods
66
86
Roma
Number (%)
Other ethnic
groups
Number (%)
Total
Number
Syphilis cases
2010
2011
2012
2013
2014
Total
3 (9.7)
1 (3.4)
6 (17.1)
3 (10.3)
4 (7.4)
17 (9.6)
28 (90.3)
28 (96.6)
29 (82.9)
26 (89.7)
50 (92.6)
161 (90.4)
31
29
35
29
54
178
Gonorrhea cases
2010
2011
2012
2013
2014
Total
5 (12.5)
9 (18.8)
14 (14.9)
16 (11.7)
15 (12.6)
59 (13.5)
35 (87.5)
39 (81.2)
89 (85.1)
121 (88.3)
104 (87.4)
379 (86.5)
40
48
94
137
119
438
Please cite this article in press as: Bjekic M, et al. Characteristics of gonorrhea and syphilis cases among the Roma ethnic group in Belgrade,
BJID 597 15
Serbia. Braz J Infect Dis. 2016. http://dx.doi.org/10.1016/j.bjid.2016.05.004
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119
ARTICLE IN PRESS
BJID 597 15
Sex
Male
Female
122
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125
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128
129
130
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133
458 (84.8)
82 (15.2)
<0.001
1 (0.2)
16 (3.0)
168 (31.1)
249 (46.1)
60 (11.1)
29 (5.4)
17 (3.1)
Marital status
Never married
Married
Divorced
49 (64.5)
27 (35.5)
0 (0.0)
444 (82.2)
81 (15.0)
15 (2.8)
<0.001
<0.001
Education
Elementary
Secondary
High
45 (59.2)
31 (40.8)
0 (0.0)
44 (8.1)
432 (80.0)
64 (11.8)
Working status
Employed
Unemployed
Pupil/student
Retired
15 (19.7)
61 (80.3)
0 (0.0)
0 (0.0)
279 (51.7)
149 (27.6)
94 (17.4)
18 (3.3)
<0.001
<0.001
68 (89.5)
8 (10.5)
344 (63.7)
196 (36.3)
<0.001
Being sexworker
Yesb
No
8 (10.5)
68 (89.5)
1 (0.2)
539 (99.8)
Source of infection
Known
Unknown
24 (21.6)
52 (68.4)
314 (58.1)
226 (41.9)
121
0.030
57 (75.0)
19 (25.0)
5 (6.6)
14 (18.4)
33 (43.4)
14 (18.4)
10 (13.2)
0 (0.0)
0 (0.0)
120
Other ethnic
groups
Age, years
15
1619
2029
3039
4049
5059
60+
Sexual orientation
Heterosexual
Homosexual
p valuea
<0.001
Gonorrhea
cases (n = 59)
Number (%)
Sex
Male
Female
10 (58.8)
7 (41.2)
47 (79.7)
12 (20.3)
Age, years
15
1619
2029
3039
4049
0 (0.0)
5 (29.4)
4 (23.5)
3 (17.7)
5 (29.4)
5 (8.5)
9 (15.2)
29 (49.2)
11 (18.6)
5 (8.5)
Marital status
Never married
Married
12 (70.6)
5 (29.4)
37 (62.7)
22 (37.3)
Education
Elementary
Secondary
11 (64.7)
6 (35.3)
34 (57.6)
25 (42.4)
Working status
Employed
Unemployed
2 (11.8)
15 (88.2)
13 (22.0)
46 (78.0)
Sexual orientation
Heterosexual
Homosexual
13 (76.5)
4 (23.5)
55 (93.2)
4 (6.4)
Being sexworker
Yes
No
6 (35.3)
11 (64.7)
2 (3.4)
57 (96.6)
Source of infection
Known
Unknown
2 (11.8)
15 (88.2)
22 (37.3)
37 (62.7)
Characteristics
p valuea
0.080
0.054
0.550
0.601
0.348
0.047
<0.001
0.046
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Discussion
The World Health Organization estimated that in 2008 there
were 10.6 million cases of syphilis and 106.1 million cases of
gonorrhea among adults globally.8 Syphilis and gonorrhea are
commonly transmitted through sexual contact (i.e. genitalgenital, genital-anorectal, oro-genital or oro-anal contact).
Moreover, syphilis has a higher transmission rate than gonorrhea and can be also transmitted by blood or through vertical
transmission from an infected mother to her baby.9 Both diseases can be followed by serious complications. Untreated
cervical gonorrhea in women can lead to pelvic inammatory disease, ectopic pregnancy and infertility.10 Syphilis is
a systemic infection and may lead to devastating cardiovas-
Please cite this article in press as: Bjekic M, et al. Characteristics of gonorrhea and syphilis cases among the Roma ethnic group in Belgrade,
BJID 597 15
Serbia. Braz J Infect Dis. 2016. http://dx.doi.org/10.1016/j.bjid.2016.05.004
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Conicts of interest
The authors declare no conicts of interest.
Please cite this article in press as: Bjekic M, et al. Characteristics of gonorrhea and syphilis cases among the Roma ethnic group in Belgrade,
BJID 597 15
Serbia. Braz J Infect Dis. 2016. http://dx.doi.org/10.1016/j.bjid.2016.05.004
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Please cite this article in press as: Bjekic M, et al. Characteristics of gonorrhea and syphilis cases among the Roma ethnic group in Belgrade,
BJID 597 15
Serbia. Braz J Infect Dis. 2016. http://dx.doi.org/10.1016/j.bjid.2016.05.004
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