Syphilis remains a global health problem with an estimated 12 million people infected each year. In Romania a decrease in the syphilis prevalence can be observed. From 2002 (12,702 cases) and 2003 (9,698 cases) until 2006 (5,657 syphilis cases) the reduction can be explained through the intensified efforts of the Ministry of Pubic Health to fight STI. The decrease is probably not related to an improvement of the general health status and not a consequence of some epidemiological prevention and control measures but probably was done by the reorientation of the patients to the general practitioners and to the private practice medical offices and to the lack of reporting of the cases. In Colentina Hospital a similar abrupt decrease of new cases was registered from 2004 (259 cases) to 2006 (110 cases). General problems related to syphilis cases recorded at Colentina Hospital included the patient presentation for consultation in the advanced stages of the disease, the socio-economic and educational factors, proxenetism and the sexual aggression of minors. There is a need in strengthening of the public health component in the control and surveillance of HIV/AIDS and STI. This may need changes in the legal framework to improve reporting and to target vulnerable groups in prevention activities. Laboratory capacity needs to be increased in order to be able to properly diagnose STI and improve the control and patient management. The reporting needs to be improved and simplified as for reporting protocol, reporting forms, case definitions to be taken into account in the renewed STI surveillance.