P004 Regional audit of the management of syphilis

Abstract

Background/introduction BASHH guidelines for syphilis management were revised in 2015 and are awaiting publication. Aim(s)/objectives To review regional clinics’ syphilis management and adherence to provisional BASHH audit standards. Methods Regional sexual health clinics were asked to review cases of syphilis diagnosed the previous year with respect to gender, sexuality, HIV status, pregnancy, screening for other sexually transmitted infections, disease stage, whether non treponemal titres were measured, follow up, treatments given, discussion of the Jarisch Herxheimer (JH) reaction and partner notification (PN). Results 13/15 (86%) clinics participated. 161 case notes were reviewed. 81% were male, 54% were classified as men having sex with men. 34/161 (21%) were HIV positive. 13/161 (19%) were pregnant (in 84% written communication had been made to obstetric/neonatal teams). 138/161 (86%) were screened for other STIs, 24% cases having concomitant STIs. 63% were early presentations. In 97% an RPR/VDRL was performed at commencement of therapy. 142/161 (88%) were treated with parenteral penicillin. The JH reaction was discussed in 49% of early STS cases. In 75% a four-fold reduction of titres in RPRs was achieved. In 37% the patient attended for follow up for 12 months (16% had no follow up). In 86% of cases PN was performed with 87/161 (54%) of contacts being verified as having attended clinics for screening and treatment. Discussion/conclusion Areas for improvement regionally include discussion of JH reaction, demonstration of success of treatment, patient follow up and partner notification. A reaudit is planned in the future.