Improved results demonstrated in the 2017 national audit of early syphilis management in the United Kingdom

Abstract

The revised British Association of Sexual Health and HIV UK guidelines on the management of syphilis were published in 2015 and this audit measures performance against those standards and recommendations. Although not included in the guideline recommendations, an exploratory question on clinics’ HIV testing policy was also included. The audit was conducted over a two-month period in 2017 in genitourinary medicine (GUM) clinics across the UK of cases presenting in 2016. A total of 161 GUM clinics participated, and data were collected for 3017 cases. The standard for adherence to recommended treatment was met (97%, standard: 97%) and almost met for documented pre-treatment syphilis serology (95%, standard: 97%). Even though only 74% of patients had a documented action in relation to informing sexual contacts (standard: 97%), the standard for contacts seen and tested per index case within four weeks was met (0.9, standard: 0.6). Finally, those clinics with a formal policy on HIV testing after a syphilis diagnosis were twice as likely to test after the HIV window period, compared to clinics without a policy; a concurrent HIV diagnosis was made in 75 (3%) patients. More work is required to standardize documented delivery of effective partner notification and a formal policy on HIV testing appears to be effective.

Population-Level Outcomes of Partner Notification Among Gay, Bisexual, and Other Men Who Report Sex With Men Diagnosed With Infectious Syphilis in British Columbia, Canada

“…In BC, of the 648 gbMSM diagnosed with syphilis, about 88% discussed PN with PHNs, short of the 97% target. Similarly, other studies reported rates of engagement with syphilis PN below target: for example, 91% at STI centers across the Netherlands, 7 74% at genitourinary clinics across the United Kingdon, 11 72% at clinics and hospitals in Los Angeles County, 9 and 69% at the Melbourne Sexual Health Center 10 . The method of delivering a PN program can contribute to patient engagement.…”

“…Although PN is a cornerstone of STI control, there are few published evaluations of syphilis PN programs. [5][6][7][8][9][10][11] In the broader literature, systematic reviews of PN strategies for STIs and HIV initially suggested that PN performed by PH may have superior outcomes to PN performed by patients. [12][13][14] However, the most recent review concluded that there was no consistent evidence to identify optimal PN strategies for any STI or HIV.…”

“…Although PN is a cornerstone of STI control, there are few published evaluations of syphilis PN programs 5–11 . In the broader literature, systematic reviews of PN strategies for STIs and HIV initially suggested that PN performed by PH may have superior outcomes to PN performed by patients 12–14 .…”