Syphilis in London circa 2004: new challenges from an old disease.

I n recent decades, cases of newly diagnosed syphilis were rare in the United Kingdom. Since 1996, however, the number of cases of primary and secondary syphilis in women has increased threefold. 2 This resurgence has been associated with a number of localised outbreaks, which have affected women of childbearing age and has been linked to the birth of at least one infant with documented congenital syphilis. Antenatal screening facilitates treatment of infectious syphilis during pregnancy and offsets vertical transmission and congenital infection. Here we report on the inadequate investigation, treatment, and follow up of pregnant women with positive antenatal syphilis serology and their infants, attending clinics at a tertiary hospital in southwest London. If similar problems are encountered at hospitals nationally, cases of congenital syphilis may go unrecognised within the UK. Given the previously low rates of congenital syphilis, clinicians may be currently relatively unfamiliar with the diagnosis and management of a potentially fatal but preventable condition in infants. Guidelines exist in both the UK and North America, 6 but there are concerns that these are not being uniformly followed. In view of the increasing rate of syphilis nationally we carried out a clinical audit of the completeness of investigation, treatment, and follow up of pregnant women with positive antenatal syphilis serology and their infants at a tertiary hospital in south London.