title: UK National Audit of Early Syphilis Management. Clinics audit: screening for and management of early syphilis.
abstract: Data were provided by 131 clinics, and 56% of cases were managed in clinics in the London regions in 2003. Three clinics (2%) do not routinely screen new patients for syphilis, and 28 clinics (21%) do not routinely screen 'rebook' patients who have had a new partner. More than 80% of clinics routinely conduct cardiovascular and neurological examinations, although chest radiography is only performed by 50% of clinics and lumbar puncture by 13%. Only 19 (14%) clinics indicated not routinely using the recommended procaine penicillin G (PPG) regimen or one- or two-dose benzathine penicillin G (BPG) regimens for early syphilis, with 57% providing two doses of BPG 2.4 g, 40% providing PPG 750 mg for 10 days, and 15% providing one dose of BPG 2.4 g. Only seven clinics (5%) indicated that they provided treatment for early syphilis with PPG that is inferior to that recommended in the national guidelines. Only 18 clinics specified using the recommended dose and duration (or in excess of this) of PPG for neurosyphilis for cases with HIV infection. Provision for management of severe penicillin reaction is good, although few patients are desensitized. All clinics report that contact tracing for early syphilis is provided, and is mainly the responsibility of health advisers. Compared with auditing outcomes, audit of management policies overestimated performance in contact tracing and provision of dark ground microscopy.
authors.affiliation: The Royal Society of Medicine, 1 Wimpole Street, London W1G 0AE, UK. Hugo.McClean@whpct.nhs.uk
authors.forename: Hugo
authors.initials: H
authors.lastname: McClean
authors.forename: David
authors.initials: D
authors.lastname: Daniels
authors.forename: Chris
authors.initials: C
authors.lastname: Carne
authors.forename: Paul
authors.initials: P
authors.lastname: Bunting
authors.forename: Rob
authors.initials: R
authors.lastname: Miller
mesh_terms: D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D016358:Contact Tracing; D004305:Dose-Response Relationship, Drug; D004359:Drug Therapy, Combination; D005260:Female; D015658:HIV Infections / Q000150:complications / Q000175:diagnosis; D006801:Humans; D008131:London; D008297:Male; D008403:Mass Screening / Q000379:methods*; D008485:Medical Audit; D010406:Penicillins / Q000009:adverse effects / Q000627:therapeutic use; D017410:Practice Guidelines as Topic; D011247:Pregnancy; D011251:Pregnancy Complications, Infectious / Q000175:diagnosis / Q000188:drug therapy; D013587:Syphilis / Q000175:diagnosis* / Q000188:drug therapy*; D013588:Syphilis Serodiagnosis / Q000379:methods*; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D000900:Anti-Bacterial Agents; D010406:Penicillins