Syphilis: old problem, new strategy

Syphilis is on the increase again. Lorraine Doherty and colleagues report on four recent localised outbreaks and recall the features of infectious syphilis, its treatment, and the public health measures needed to contain it Infectious syphilis is a disease of considerable public health importance, with overwhelming health effects if it is not treated. These include cardiovascular and neurological disease and adverse pregnancy outcomes, such as stillbirth and congenital syphilis. Further, concurrent infection with syphilis can facilitate transmission of HIV.1 Syphilis is most infectious through sexual contact during the primary or secondary stages (see box 1), but transmission can also occur during the early latent stage.2 Syphilis is preventable, and treatable with effective and inexpensive antibiotics. The possible resurgence of infectious syphilis, a disease previously believed to be close to eradication, is a matter of increasing global concern.3–6 This article outlines recent changes in the epidemiology of infectious syphilis in England, including the features of a number of outbreaks. It aims to increase health professionals' awareness of the clinical features of infectious syphilis, and to consider approaches to the investigation and control of syphilis and other outbreaks of sexually transmitted infection. #### Summary points Untreated infectious syphilis may have a number of very serious health effects Recently there has been an upward trend in incidence, partly due to several localised outbreaks affecting homosexual men and heterosexual men and women These outbreaks have emphasised the importance of investigating wider sexual networks as well as tracing individual contacts to identify further cases and prevent further spread The general public, certain groups at risk, and relevant health professionals should be aware of the risks of acquiring syphilis and the symptoms and signs of acute infection Between the 1960s and the late 1970s homosexually acquired syphilitic infection increased, in keeping with liberalisation of …