International Journal of STD & AIDS > Volume 17, Number 5 > Pp. 340-343

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Audit reports

UK National Audit of Early Syphilis Management. Case-notes audit: contact tracing, information giving, follow-up and outcomes

Hugo McClean, David Daniels, Chris Carne, Paul Bunting, Rob Miller and The National Audit Group of the British Association for Sexual Health and HIV

The Royal Society of Medicine, 1 Wimpole Street, London W1G 0AE, UK; The Royal Society of Medicine, 1 Wimpole Street, London W1G 0AE, UK; The Royal Society of Medicine, 1 Wimpole Street, London W1G 0AE, UK; The Royal Society of Medicine, 1 Wimpole Street, London W1G 0AE, UK; The Royal Society of Medicine, 1 Wimpole Street, London W1G 0AE, UK

Contact tracing was provided for 683/781 (87%, regional range 57–97%) cases, and identified 997 traceable contacts of whom 511 (51%) were seen, short of the recommended standard of 60%. However, the performance range for this standard was 26–70%, with seven regions achieving 60% or more. Of 511, 215 (42%, range 3–73%) contacts had syphilis. Treatment completion was recorded for 691 (88%, range 71–100%) cases, and resolution of lesions for 348/469 (74%, range 40–96%) cases. Nationally, 419/764 (55%, range 37–70%) cases were recorded as having a two dilution (four-fold) or greater decrease in non-treponemal test titre within 3–6 months after treatment; not achieving this titre decrease was mainly attributable to non-attendance for follow-up and failure of titre levels to fall. Follow-up of infectious syphilis in UK genitourinary medicine clinics is poor and falls far short of that recommended by National Guidelines. Only 16 (2%) cases had follow-up at intervals approximating to 1, 2, 3, 6 and 12 months, and only 312 (40%, range 5–61%) cases attended at least two follow-up visits. Only 17 (7%) of all 236 oral treatments (including switches to oral treatment), and 33 (27%) of 123 cases with HIV infection were recorded as designated annual follow-up. Further work is needed to determine factors that account for the wide variation between regions in contact tracing and follow-up performance.

Key Words: SYPHILIS • MEDICAL AUDIT • NURSING AUDIT • CONTACT TRACING • PATIENT EDUCATION • OUTCOME ASSESSMENT (HEALTH CARE)

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