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Many HIV clinics now offer regular sexual health screening. Cohen et al went further and added syphilis screening into routine blood tests for people followed up for HIV care. In a one year period, 2389 syphilis tests were carried out when patients had routine CD4 tests. Forty early, asymptomatic syphilis cases were identified, a rate of 7.3 per 1000 patient years, and accounting for 36% of infectious syphilis cases at the centre.
See p 217
Another recommended approach to syphilis case-finding in an outbreak is to move off site. Lambert and colleagues in Brighton followed this advice and took screening to various gay venues. They compared venepuncture, "only a little prick", with use of a recently validated saliva test, "suck it and see". Coverage of venue users was around 10% with both approaches, and six early syphilis cases were found from 1090 tests. There was better uptake of salivary than
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