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After the “velvet revolution” in 1989 the population of the Slovak Republic had “opened to the world”. The mobility of the inhabitants increased considerably. The main reasons were as follows: workers’ migration abroad, an intensive and widespread active and passive tourism, and diVerent travel activities. Changes in sexual behaviour were expressed, especially, in homosexual men, sexual liberty in general, enhanced promiscuity, and prostitution. This development after 1989 was distinctively reflected in the incidence of venereal diseases, especially of syphilis (table 1). Between 1990 and 1996 the number of notified patients with syphilis increased nearly five times. This trend was expressed more in the group of patients with early syphilis where the number of cases increased from eight to 111—that is, 14 times (syphilis I increased six times, syphilis II recens and recidivans almost 17 times). The number of cases with congenital syphilis remained stable, although the incidence of syphilis in pregnant women (syphilis gravidarum) increased yearly from 1 to 8 (table 1). The trend in the incidence of gonorrhoea had diVerent features (table 2). Between 1990 and 1996 the incidence decreased from 1950 to 224—that is, 11.5% of the notified cases in 1990. The number per 100 000 inhabitants had decreased from 37.5 in 1990 to 4.2 in 1996. The rates in the former departments of the Slovak Republic showed a similar tendency. In Bratislava the decline was 21%, in the western Slovak department 24.1%, in the middle Slovak department 5.3%, and in the east Slovak department only 4.5%. In some big towns, for example, in Banska Bystrica it fell to 1.9% and in Kosice to 0.7%. This declining tendency in the number of notified cases of gonorrhoea is also seen in the sexually most active age group (15–24 years), but the percentage out of the total number of cases of gonorrhoea is 64%– 67%. The occurrence of chronic gonorrhoea, especially in females, is appreciable. At present it is diYcult to conclude whether this trend is a result of better prevention because of fear of HIV infection (frequent use of condoms) or failure in notification of gonorrhoea (considered as a facile disease treated by a single injection). Gonorrhoea is frequently treated but not notified by general practitioners and other specialists and self treatment of gonorrhoea is also evident. Also, because the gonorrhoea notification form contains the patient’s initials, ID number, and his/her exact address, this may be a reason not to notify certain patients. On the other hand, there are indications of similar approaches from other medical specialists. Preventive corrective measures may be focused on syphilis to improve contact findings, serological testing for syphilis in expectant mothers, and the serological screening for syphilis during the hospitalisation. In gonorrhoea exact contact tracings may uncover further infected people and, in analysing its course and treatment, it may be necessary to apply these measures in the departments and towns where the significant decrease of gonorrhoea has been reported. Great importance should be attached to intensive hygiene and sex education in the age groups most threatened. Global view

Actual trends of the incidence of syphilis and gonorrhoea in the Slovak Republic in the years 1990-6.