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Although we may wish it were not so, syphilis, like the poor, will always be with us—at least for the foreseeable future. The levels of both are determined to a large extent, by political instability and socioeconomic deprivation. Overall, the incidence of syphilis is low in Western Europe (approximately 0.3 cases/100 000 in England in 1998)1 although it has reached epidemic proportions in the Russian Federation where the levels in 1996 exceeded 900 cases/100 000 in men and women in the 20–29 year old age group.2 The need to maintain effective strategies for syphilis control, which must include diagnosis and management, in areas of low prevalence such as the United Kingdom, is reinforced by the recent local outbreak of heterosexually acquired syphilis in South West England3 as well as the marked increase in homosexually acquired infection in the Manchester area.4 A significant proportion of the infected men in Manchester were HIV positive so the overall community health gain from rapid and effective diagnosis extends well beyond syphilis: ulcerative sexually transmitted infections promote HIV transmission by augmenting HIV infectiousness and HIV susceptibility via a variety of biological mechanisms.5 The importance of the serological diagnosis of syphilis has now been recognised with the publication of the excellent guidelines for serological testing for syphilis in diagnostic microbiology laboratories by the PHLS Syphilis Serology Working Group.6 These complement the recent national guidelines on the management of syphilis7,8 and together they should improve the overall diagnosis and management of syphilis within the United Kingdom and beyond.
Guidelines for serological diagnosis for syphilis are long overdue. The last guidelines which were produced by the World Health Organization in 19829 recommended the use of a cardiolipin antigen test such as the Venereal Diseases Reference Laboratory (VDRL) or rapid …