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Syphilis still remains uncommon, but the incidence of syphilis infection is the highest it has been since records began. Untreated syphilis is often asymptomatic, but can cause a wide array of symptoms and long term complications. Morbidity and prevention of transmission to sexual partners or vertical transmission during pregnancy can all be prevented by early testing and treatment. Syphilis is treated with a course of antibiotics under specialist care and follow up by a consultant in Sexual Health.
Syphilis is easily diagnosed and treated and has public health implications. If struggling to find a cause, faced with unusual or unexplained symptoms or results, it is worth excluding syphilis and HIV.
Serology blood test (brown blood tube, microbiology form) requesting syphilis screening.
If the patient has a past history of syphilis, this should be stated in the clinical details section of the request form.
REFER URGENTLY to Highland Sexual Health for further management/advice. Do not wait for full serology (this can take a few weeks).
Positive syphilis screening will automatically trigger laboratory referral for full serological testing on the same sample.
It is good practice for the team who requested the initial test to inform the patient of the preliminary result and advise them that they are being referred to Highland sexual health for further advice and management.
A second confirmatory test is required, which can either be carried out by the referring team, or at the time of review by Highland Sexual Health.
Partner notification is part of the management of a confirmed syphilis infection and will be carried out by Highland Sexual health team.
All positive results of syphilis in pregnancy should be referred urgently to Highland Sexual Health to determine whether-or-not this represents active infection, past treated infection, recurrent infection, or false positive result.
Management of confirmed syphilis infection in pregnancy should be through involvement of Sexual health with obstetrics, paediatrics, midwife and GP.
Referral to foetal medicine/paediatrics should be made for pregnant women who are treated for syphilis during the current pregnancy. If treatment for syphilis occurs less than 4 weeks before delivery, the neonate will require treatment.
Template birth plan: https://www.bashhguidelines.org/media/1196/syphillis-bp_print_2016_p3.pdf
All patients with positive syphilis tests should be referred urgently to Highland Sexual Health
Syphilis guidelines: https://www.bashhguidelines.org/current-guidelines/genital-ulceration/syphilis-2015/
Syphilis in pregnancy birth plan template: https://www.bashhguidelines.org/media/1196/syphillis-bp_print_2016_p3.pdf
Preliminary patient information should be given in a non-judgemental, sympathetic manner:
Patient information leaflet link: https://www.bashhguidelines.org/media/1037/sts_pil_non-pregnant_digital_2016.pdf
Leaflet for pregnant women: https://www.bashhguidelines.org/media/1036/sts_pil_digital_2016.pdf
Last reviewed: 31 October 2020
Next review: 31 October 2023
Approved By: TAM Subgroup of ADTC
Reviewer Name(s): Consultant in GUM/HIV
Document Id: TAM457