Collaboration is key to preventing syphilis

BMJ 2002; 325 doi: http://dx.doi.org/10.1136/bmj.325.7372.1116/a (Published 09 November 2002) Cite this as: BMJ 2002;325:1116
  1. Kevin A Fenton, consultant epidemiologist (kfenton{at}phls.org.uk),
  2. Lorraine Doherty, senior medical officer
  1. HIV/STI Division, PHLS Communicable Disease Surveillance Centre, London NW9 5EQ
  2. Department of Health, Social Services and Public Safety, Belfast BT4 3SJ

    EDITOR—The letter by Clark et al about the epidemiological data represented in our paper on the resurgence of infectious syphilis implies that we did not consult with local colleagues in preparing our paper and that the situation in Manchester has thereby been “misrepresented” to the detriment of the genitourinary medicine clinics dealing with the increased workload. 1 2 In fact the collaboration between the Communicable Disease Surveillance Centre and colleagues in genitourinary medicine on the frontline was close and productive, as evidenced by the fact that representatives from clinics at each outbreak site participated in all aspects of preparing the report.

    Data from enhanced surveillance systems, such as that instituted in Manchester, provide more sensitive information. By collaborating with local clinicians, we made every effort to ensure that figures obtained from each site were as current as possible at the time of submission. However, the explosive nature of the outbreak, coupled with the attendant reporting and publishing delays, may have contributed to the disparity in the data noted by Clark et al. Rather than suggesting that any of the outbreaks had ended, we aimed to raise awareness among health professionals about the resurgence of infectious syphilis in England and to reiterate key aspects of its clinical management and public health control and the central importance of clinics.

    Through its national and regional offices the Communicable Disease Surveillance Centre has continued to work with local partners in identifying and managing these and other outbreaks of sexually transmitted diseases in England. This robust collaboration between genitourinary medicine, public health, microbiology, and the voluntary sector has raised awareness of outbreaks and facilitated the development of national guidelines on controlling outbreaks of sexually transmitted diseases3; a new national enhanced surveillance programme for infectious syphilis; revision of clinical guidelines on syphilis management; additional investment into local prevention initiatives; and research aimed at developing new diagnostic assays for infectious syphilis. This process has been overseen by a national advisory committee, which has formal representation from a range of stakeholders in sexual health.

    We sincerely hope that our hard pressed colleagues in genitourinary medicine will continue to recognise the added value of working with their public health colleagues in investigating outbreaks of sexually transmitted disease. We also hope that they will continue to collaborate with the Communicable Disease Surveillance Centre, a process that was extremely helpful in the syphilis outbreaks.


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