Symptomatic secondary syphilis: empirical antimicrobial treatment or await microbiology?
Daniel Richardson
A B C D , Colin Fitzpatrick A , Fionnuala Finnerty A and Debbie Williams A
A Brighton & Sussex University NHS trust, Brighton, Department of Sexual Health, Brighton BN2 5BE, UK.
B Brighton & Sussex Medical School, Brighton BN2 5BE, UK.
C Present address: Western Sydney Sexual Health Centre, 162 Marsden Street, Parramatta, NSW 2150, Australia.
D Corresponding author. Email: daniel.richardson2@health.nsw.gov.au
Sexual Health 16(6) 598-599 https://doi.org/10.1071/SH19079
Submitted: 9 May 2019 Accepted: 12 June 2019 Published: 31 October 2019
Abstract
Men who have sex with men (MSM) with symptomatic secondary syphilis present with characteristic symptoms of rash, fever and lymphadenopathy; due to delays in microbiology results and some patients failing to return for treatment, empirical treatment is sometimes offered. We reviewed all patients presenting with secondary syphilis diagnosed on the basis of clinical symptoms and signs and reviewed treatment. Of the 36 patients, 16 MSM (44%; 95% confidence interval (CI) 27.8–60.2%) were treated empirically, whereas treatment was delayed for 20 (56%; 95% CI 39.8–72.2%) waiting for microbiology results. Treatment delays were longer for HIV-negative than HIV-positive MSM (10 vs 5 days respectively; P = 0.01); the cumulative treatment delay was 143 days. Concerns over antimicrobial resistance and overuse of antimicrobials should drive the use of point-of-care testing for syphlis.
Additional keywords: empirical treatment, men who have sex with men.
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