40 | Nursing in Practice | Spring 2023
SEXUAL HEALTH
Don ’ t miss symptoms of syphilis
Sexual health specialist nurse Jodie Crossman advises on how to recognise symptoms of syphilis and the treatment options available
What is syphilis ? Syphilis is one of the oldest known sexually transmitted infections ( STIs ). Caused by the bacteria Treponema pallidum , its origins are not fully known , but the first written records of it in Europe date back to 1494 .¹ By the 1600s , syphilis had become one of the main public health concerns , and in the late 1800s up to 20 % of adults had received treatment for the infection .² Following the discovery of penicillin as a treatment in 1943 3 and later the increase in condom use and abstinence during the 1980s HIV epidemic⁴ , prevalence in the UK fell sharply .
However , since the early 1990s , the rate of syphilis diagnosis has risen year on year in the UK , with an increase of 1,200 % between 1997 and 2007⁴ and a further tripling between 2010 and 2020 . ⁵
Although this dramatic increase initially affected mostly gay , bisexual and other men who have sex with men , heterosexual diagnoses have also risen steeply over the past decade⁵ , so there is now no typical ‘ at risk ’ group . It is incumbent on all health professionals to be aware of the disease and its symptoms to prevent long-term negative effects on individuals .
Why is this relevant to general practice ? The neighbourhood setting of the GP surgery means practice nurses may see unusual presentations , or patients who would not typically attend a sexual health clinic . Any unusual or non-resolving symptoms should incorporate syphilis as a differential diagnosis until ruled out by serology .
Syphilis can have a devastating effect on mother and child during pregnancy . All pregnant patients attending general practice should be encouraged to have their routine screening tests , with special caution for those presenting late , those recently arrived in the UK or those who have changed sexual partner during pregnancy .
Patients may also present with a range of symptoms ( as discussed below ), so maintain a low threshold for referral to sexual health clinics , even if people believe themselves to be at a low risk . Discussions on cervical screening and contraception are also a good opportunity to offer sexual health screening in general practice .
Syphilis testing also presents an opportunity to screen for other bloodborne infections such as HIV , which may have similar impacts on long-term health .
Practice nurses may see unusual presentations , or patients who would not typically attend a sexual health clinic