GPs urged to be vigilant as syphilis cases soar

Health Protection Agency data show that UK rates of syphilis in males increased 20-fold between 1998 and 2006.

GPs should be more vigilant in looking for cases of syphilis in light of a resurgence of the disease, say US researchers.

Since 1996, syphilis has been on the increase in many northern and western European Union countries. In the UK, cases were initially observed in larger cities, but have now progressed to suburban and rural settings.

Between 1998 and 2006, UK rates of diagnoses of syphilis in males increased 20-fold to reach nine per 100,000 men, according to Health Protection Agency figures.

But despite the increasing number of cases, researchers from the US Centres for Disease Control and Prevention in Atlanta warn that clinicians are struggling to diagnose the disease.

The researchers say the low incidence of syphilis in developed countries over the past two decades and the interactions of the disease with HIV infection mean that clinicians are unfamiliar with the disease's many manifestations.

They conclude that 'renewed vigilance among and training of healthcare professionals to help deal with the rise in syphilis' is required.

Dr Colm O'Mahony, a consultant in sexual health in Chester and spokesman for the British Association for Sexual Health and HIV, said that it was 'incredible' that a medieval disease like syphilis could return.

'We have seen a huge increase in the number of syphilis cases in our area,' he said. 'Over the past couple of years the number of cases per year has increased from one or two to around 30. And at least 10 of those cases had been missed in primary care.'

GPs definitely need to be looking out for cases of syphilis, but at the moment the average GP has no familiarity with the disease, said Dr Mahony.

They should identify the rash of secondary syphilis and then order a simple blood test to diagnose the disease, he said.

South London GP Dr Clare Gerada, a member of the RCGP sex, drugs and HIV working group, said: 'I do not think GPs require further training on syphilis, they just need to be alert to the fact that it is out there.'

The Lancet Infectious Diseases 2008; 8:244-53

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