† Gummatous syphilis: 22 typical nodules/plaques or ulcers; † Neurosyphilis: ocular, auricular, meningovascular, parenchymatous (general paresis, tabes dorsalis); asymptomatic (abnormal cerebrospinal fluid [CSF]); † Cardiovascular syphilis: aortitis-asymptomatic, angina, aortic regurgitation, stenosis of coronary ostia, aortic aneurysm (mainly thoracic). Epidemiological monitoring of infectious syphilis: all patients with primary, secondary and early latent syphilis should be reported to their National Syphilis Surveillance System and these national programmes should report to the European Surveillance of STI (ESSTI) network of the ECDC, if they are within the European Union. 1

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HIV-positive patients: Treat as appropriate for stage of infection, that is, HIV-positive patients are treated with the same regimens as HIV-negative patients † Management of sexual partners: Recognition that partner notification may be difficult in context of current syphilis outbreaks and achieving 60% partner notification rates is not always possible and screening in high-risk venues may be appropriate. † Auditable outcomes: Measuring rapid plasma reagin test (RPR)/Venereal Diseases Research Laboratory (VDRL) at commencement of therapy introduced as an auditable outcome. † Appendices:-Reference to sources of procaine penicillin G-Use of lidocaine as diluent for Benzathine penicillin G DIAGNOSIS History and examination † Symptoms of early syphilis † Details of previous treatment (place of treatment, diagnosis made, treatment given, RPR/VDRL titre at discharge) † Obstetric history, potential complications of syphilis e.g. miscarriages, stillbirths † Blood donation and antenatal screening history † Other treponemal infections; yaws, pinta and a history of living in countries where these conditions are endemic † In early infection examination of the genitals, skin, mucosal surfaces and lymph nodes for signs of primary and secondary syphilis. † In late and congenital syphilis a thorough clinical examination should be undertaken for the clinical manifestations of syphilis. This should include a full systems review including skin and mucosal surfaces, lymph nodes, cardiovascular and neurological systems.

The sequence of the bla ARI-1 gene from imipenem-resistant Acinetobacter baumannii 6B92 has been determined. The structural gene encodes a 273-amino-acid protein which is most related to the OXA class D ␤-lactamases. The conserved S-T-F-K and K-T-G motifs were identified in the ARI-1 protein sequence, also named OXA-23, but significantly, a point mutation (Y3F) was identified in the Y-G-N conserved motif, also known to function in the active site.