title: UK National Audit of Early Syphilis Management. Case-notes audit: contact tracing, information giving, follow-up and outcomes.
abstract: Contact tracing was provided for 683/781 (87%, regional range 57-97%) cases, and identified 997 traceable contacts of whom 511 (51%) were seen, short of the recommended standard of 60%. However, the performance range for this standard was 26-70%, with seven regions achieving 60% or more. Of 511, 215 (42%, range 3-73%) contacts had syphilis. Treatment completion was recorded for 691 (88%, range 71-100%) cases, and resolution of lesions for 348/469 (74%, range 40-96%) cases. Nationally, 419/764 (55%, range 37-70%) cases were recorded as having a two dilution (four-fold) or greater decrease in non-treponemal test titre within 3-6 months after treatment; not achieving this titre decrease was mainly attributable to non-attendance for follow-up and failure of titre levels to fall. Follow-up of infectious syphilis in UK genitourinary medicine clinics is poor and falls far short of that recommended by National Guidelines. Only 16 (2%) cases had follow-up at intervals approximating to 1, 2, 3, 6 and 12 months, and only 312 (40%, range 5-61%) cases attended at least two follow-up visits. Only 17 (7%) of all 236 oral treatments (including switches to oral treatment), and 33 (27%) of 123 cases with HIV infection were recorded as designated annual follow-up. Further work is needed to determine factors that account for the wide variation between regions in contact tracing and follow-up performance.
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; D005260:Female; D005500:Follow-Up Studies; D015658:HIV Infections / Q000150:complications / Q000453:epidemiology; D006801:Humans; D008131:London; D008297:Male; D008485:Medical Audit; D010353:Patient Education as Topic; D013587:Syphilis / Q000175:diagnosis / Q000188:drug therapy* / Q000635:transmission; D013588:Syphilis Serodiagnosis / Q000379:methods; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D000900:Anti-Bacterial Agents