Dilemmas in the management of syphilis.

A recent U.S. survey demonstrated wide variation in the management of syphilis. 25/31 (73.5%) Consultants and Specialist Registrars in Infectious Diseases and Genitourinary Medicine, in Ireland were surveyed. 23 (92%) treat more than 50 HIV patients a year, 18 (72%) had been consulted on a patient with syphilis in the last year. With secondary syphilis, 13 (52%) give 3 doses of benzathine penicillin, while 10 (40%) give one, no statistical difference between consultants and SpRs (p = 0.9). Significant variation in the investigation and management of syphilis in Ireland was identified. There is a need for the development of Irish national guidelines on the management of syphilis.