title: The re-emergence of syphilis in the United Kingdom: the new epidemic phases.
abstract: OBJECTIVE
  The objective of this study was to characterize the resurgence of infectious syphilis in the United Kingdom between 1997 and 2003.
  
  
  METHODS
  The authors conducted a retrospective analysis of routine surveillance data from genitourinary medicine clinics and data collected through enhanced surveillance.
  
  
  RESULTS
  Between 1997 and 2002, diagnoses of primary, secondary, and early latent syphilis made at genitourinary medicine clinics increased by 213% in heterosexual males, 1412% in men who have sex with men (MSM), and 22% in females. These increases have been driven by a series of outbreaks, the largest of which were seen in Manchester (528) and London (1222) up to the end of October 2003. All the outbreaks have been geographically localized and the majority of cases occurred in MSM. A high percentage of concurrent HIV infection was reported, and oral sex was often reported as a route of transmission.
  
  
  CONCLUSIONS
  Syphilis has re-emerged in response to behavior change, probably driven by changes in the HIV epidemic. The future course of the epidemic is difficult to predict and control remains elusive.
authors.affiliation: Health Protection Agency Communicable Disease Surveillance Centre, London, UK. ian.simms@hpa.org.uk
authors.forename: Ian
authors.initials: I
authors.lastname: Simms
authors.forename: Kevin A
authors.initials: KA
authors.lastname: Fenton
authors.forename: Matthew
authors.initials: M
authors.lastname: Ashton
authors.forename: Katherine M E
authors.initials: KM
authors.lastname: Turner
authors.forename: Emma E
authors.initials: EE
authors.lastname: Crawley-Boevey
authors.forename: Russell
authors.initials: R
authors.lastname: Gorton
authors.forename: Daniel Rh
authors.initials: DR
authors.lastname: Thomas
authors.forename: Audrey
authors.initials: A
authors.lastname: Lynch
authors.forename: Andrew
authors.initials: A
authors.lastname: Winter
authors.forename: Martin J
authors.initials: MJ
authors.lastname: Fisher
authors.forename: Lorraine
authors.initials: L
authors.lastname: Lighton
authors.forename: Helen C
authors.initials: HC
authors.lastname: Maguire
authors.forename: Maria
authors.initials: M
authors.lastname: Solomou
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D021821:Communicable Diseases, Emerging / Q000453:epidemiology / Q000209:etiology / Q000517:prevention & control; D004196:Disease Outbreaks; D005260:Female; D006801:Humans; D008297:Male; D008499:Medical Records; D008875:Middle Aged; D012189:Retrospective Studies; D012725:Sexual Behavior; D013587:Syphilis / Q000453:epidemiology* / Q000209:etiology / Q000517:prevention & control; D006113:United Kingdom / Q000453:epidemiology