Nearly 3,000 cases of syphilis were diagnosed in London in 2016 and high numbers continue to be diagnosed. Although the majority are in men who have sex with men, heterosexuals are also affected. In 2016 cases came from all local authorities in London, with the following areas having 100 cases of more – Lambeth, Southwark, Westminster, Tower Hamlets, Camden, Hackney, Wandsworth, Islington, Kensington and Chelsea, Hammersmith, and Lewisham.
Why is it important for Primary Care practitioners to consider syphilis?
Many patients with syphilis remain completely symptomless and may only be diagnosed by performing treponemal serology. For those who develop symptoms, some may have an ulcer or sore on the genitals or in the mouth. In most cases the ulcer is completely painless and usually disappears by itself. Then, some weeks later, some people develop a skin rash, fevers and swollen glands. As these symptoms are not very specific, people affected and even doctors may mistakenly believe that the symptoms are due to flu or some other viral illness.
Please find below a summary of the key clinical features of early syphilis. As many patients remain completely symptomless, and may only be diagnosed by performing treponemal serology please consider syphilis as a diagnosis in sexually active people presenting with suggestive symptoms, particularly genital lesions or generalised rashes. All women should also receive antenatal syphilis testing and be retested during the pregnancy if there is ongoing risk of acquisition.
If you recognise these symptoms in your patients, or feel your patients may have been at risk, please:
Yours sincerely
Deborah Turbitt
Deputy Regional Director for Health Protection, PHE London