International Journal of STD & AIDS > Volume 16, Number 5 > Pp. 348-352

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Original Research Articles

Screening, diagnosis and management of early syphilis in genitourinary medicine clinics in the UK

K E Rogstad, I Simms, K A Fenton, S Edwards, M Fisher and C A Carne

Royal Hallamshire Hospital, Sheffield, UK; Health Protection Agency, Communicable Disease Surveillance Centre, London, UK; Health Protection Agency, Communicable Disease Surveillance Centre, London, UK; West Suffolk Hospital, Bury St Edmunds, Suffolk, UK; Brighton Health Care Trust, Brighton, UK; Clinic 1A, Box 38, Addenbrooke's Hospital, Cambridge CB2 2QQ, UK

New diagnoses of syphilis in the UK increased eight-fold between 1997 and 2002. This study, conducted in 2002, demonstrated that 31% of clinics were not confident of their expertise to obtain an adequate specimen for dark ground microscopy (DGM), and 35% were not confident of their expertise to detect treponemes on DGM. In all, 64% of clinics had observed adherence problems in HIV-positive patients treated with parenteral regimens, as against 42% with oral regimens. Also, 51% of clinics waited more than a week for the results of initial serological tests for syphilis, and 88% of clinics waited more than a week for confirmatory test results. Other concerns include the failure to perform syphilis serology consistently whenever HIV-positive patients were at risk, and the widespread use of doxycycline as a therapy for syphilis in HIV-positive patients despite concerns that this is not known to be fully treponemicidal in cerebrospinal fluid.

Key Words: SYPHILIS • SCREENING • DIAGNOSIS • THERAPY • SEXUALLY TRANSMITTED

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