Thursday July 12, 2018
There has been a trend both locally, nationally and internationally of an increase in the number of syphilis cases being seen. If left untreated this condition can cause significant mortality and morbidity.
Worryingly there has been several cases of congenital syphilis locally in the past year. It may be a condition that many of us have not had much experience with.
Some key points are:
- Most cases are in MSM (men who have sex with men) but the number of cases in women is also rising. Don’t forget to ask about sexual behaviours when doing a STI screen as 50% of MSM do not disclose this to their GP unless asked.
- It can occur at any age after sexual debut, although most common in young men aged 20-34 and in women of childbearing age. There have been cases in the 70+ age group.
- A quarter of positive tests in MSM are for asymptomatic STI screening. Think about doing , as a minimum, an annual screen in this group. For high-risk MSM it should be 6- or even 3-monthly.
- Congenital syphilis is an entirely preventable disease – ALWAYS screen at first antenatal visit but also repeat if there is any change in sexual partner.
- If you suspected herpes with a genital ulcer and the test is negative THINK of syphilis as an alternative diagnosis. In fact, best practice is to test at the first presentation any genital ulcer for syphilis as well.
- The sexual health services are more than willing to offer advice and support if you do come across any cases. The patient can be referred via an e-Referral in BPAC.
Resources to help improve your knowledge and confidence in screening, identifying and treating this disease:
- Syphilis Management Guidelines
- Video of a recent local sexual health education day with a talk given on syphilis by Dr Jane Morgan. Please contact firstname.lastname@example.org for the link (not for general public release, for health professionals only. Please be mindful of this if sharing with others.)
- NZSHS website - http://www.nzshs.org/guidelines
REMEMBER A SEXUAL HEALTH SCREEN IS NOT COMPLETE WITHOUT TESTING FOR SYPHILIS AND HIV SEROLOGY