title: Clinical diagnosis of syphilis: a ten-year retrospective analysis in a South Australian urban sexual health clinic.
abstract: National notifications for infectious syphilis in Australia have increased in recent years. Outside of sexual health clinics, junior clinicians seldom encounter this disease in its infectious stage (primary, secondary and early latent). With such a variable clinical presentation, textbook teaching is no substitute for real-life experience. The importance of accurate classification and staging of disease is relevant to the risk of transmission and determines treatment duration. In this article, the authors review the clinical presentation of syphilis over ten years in an urban sexual health clinic with a focus on the clinical presentation and diagnosis of infectious syphilis, in particular secondary syphilis, compared with that outlined in the Australian National Notifiable Diseases Surveillance System guidelines. This retrospective review of all patients diagnosed with syphilis at an urban sexual health clinic showed that between 2005 and 2015, 226 cases of syphilis were diagnosed. Documentation of impression of clinical staging of disease was present in 46% of the cases. Seventeen of these cases were recorded as secondary syphilis. The criteria used by clinicians to diagnose the secondary syphilis cases were consistent with criteria defined by the Australian National Notifiable Diseases Surveillance System. All cases of secondary syphilis had at least one cutaneous manifestation of disease. The demographic of the cohort of syphilis cases was consistent with that recorded in the literature. This review showed that the clinician's diagnosis of secondary syphilis in this service is consistent with the National Notifiable Diseases Surveillance System guidelines. Continuing education of junior medical staff is important to facilitate diagnosis and improve documentation of clinical staging, minimise disease transmission and ensure appropriate treatment.
authors.affiliation: Dermatology registrar, Royal Adelaide Hospital, Adelaide, South Australia, Australia charlotteforrest1@gmail.com.
authors.forename: C E
authors.initials: CE
authors.lastname: Forrest
authors.affiliation: Consultant Sexual Health Physician, Clinic 275 STD Services, Royal Adelaide Hospital, Adelaide, South Australia, Australia.
authors.forename: A
authors.initials: A
authors.lastname: Ward
mesh_terms: D000328:Adult; D001315:Australia / Q000453:epidemiology; D054869:Clinical Audit; D018563:Disease Notification / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D008297:Male; D011159:Population Surveillance / Q000379:methods*; D060728:Reproductive Health; D012189:Retrospective Studies; D013587:Syphilis / Q000175:diagnosis* / Q000453:epidemiology; D014210:Treponema pallidum / Q000302:isolation & purification*; D014505:Urban Population
keywords: Australia; Syphilis; Treponema pallidum; diagnosis; sexually transmitted infection