Intended for healthcare professionals

Rapid response to:

Education And Debate

Syphilis: old problem, new strategy

BMJ 2002; 325 doi: https://doi.org/10.1136/bmj.325.7356.153 (Published 20 July 2002) Cite this as: BMJ 2002;325:153

Rapid Response:

"Safer sex", sexual orientation and syphilis

EDITOR,

The timely reminder that syphilis is coming back (1) whilst both
necessary and, for the most part helpful, never-the-less perpetuates two
common sources of confusion when discussing many STIs.

First, the lead key point that ‘ “Safer sex” messages need continual
reinforcement ‘ should rather be that ‘”Safer sex” messages need
clarification and re-definition’. In one of the most popular primary care
texts on sexual health, unprotected oral sex is listed in the 'Possibly
safe/medium risk' category.(2) Clearly reinforcing this ‘safer-sex’
message will further the spread of syphilis rather than reducing it.

Doherty et al seem unaware that oral sex has hitherto been an
integral component of the safe sex message and therefore, in popular
understanding, their second key point in Box 2 is contradicted by the
first.

Secondly, the paper perpetuates the myth that the risk of syphilis in
the UK is equally divided between “sections of the sexually active
heterosexual and homosexual populations" who “fail to protect themselves.”
Of the 276 cases of syphilis noted, 204 were in homosexual men. Since men
who have had sex with men within the past five years comprise 2.6% of the
population (3) and 73.9% of the syphilis cases, to put heterosexuals first
in any description of those at risk seems more politically than
epidemiologically correct.

Trevor Stammers,

Honorary Senior Tutor in General Practice, St. George’s Hospital
Medical School, London

References

1. Doherty L, Fenton KA, Jones J, Paine T et al Syphilis: old
problem, new strategy BMJ 2002 325 153-6
2. Curtis H, Hoolaghan T, Jewitt C Sexual health promotion in general
practice Radcliffe Press 1995 p4
3. Johnson AM, Mercer CH, Erens B, Copas A et al Sexual behaviour in
Britain: partnerships, practices and HIV risk behaviours Lancet 2001 358
1835-42

Competing interests: No competing interests

21 July 2002
Trevor G Stammers
Honorary Senior Tutor in General Practice, St. George’s Hospital Medical School, London
St George's Hospital Medical School, London