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Original research
Lessons learnt from syphilis-infected blood donors: a timely reminder of missed opportunities
  1. Heli Harvala1,2,
  2. Claire Reynolds3,
  3. Alvin Fabiana1,
  4. Joanne Tossell1,
  5. Gillian Bulloch4,
  6. Susan Brailsford1,3,
  7. Stuart Blackmore5,
  8. Louise Pomeroy6
  1. 1Microbiology Services, NHS Blood and Transplant, London, UK
  2. 2Infection and Immunity, University College of London, London, UK
  3. 3NHS Blood and Transplant/ Public Health England Epidemiology Unit, NHS Blood and Transplant, Colindale, UK
  4. 4Clinical Support Team, NHS Blood and Transplant, Newcastle, UK
  5. 5Clinical Services, Welsh Blood Service, Pontyclun, UK
  6. 6Irish Blood Transfusion Service (ISBT), NAT Laboratory, Dublin, Ireland
  1. Correspondence to Dr Heli Harvala, Microbiology Services, NHS Blood and Transplant, Colindale, UK; heli.harvalasimmonds{at}


Objective Due to the increased number of syphilis infections diagnosed in the UK and beyond, we reviewed our data on blood donors infected with syphilis in the UK and Ireland between 2016 and 2019.

Methods Data were extracted from the surveillance database for all blood donors confirmed positive for syphilis in the UK and Ireland between 2016 and 2019, together with the total number of donations tested during that period. Data on positive cases included gender, age group, reported treatment, symptoms and confirmatory results. All cases were divided into recently acquired within 24 months and past syphilis infection. We also reviewed the information on symptoms characteristic of syphilis reported by blood donors with an untreated syphilis infection during the postdonation discussions.

Results Screening of 8 246 600 blood donations for treponemal antibodies identified 316 blood donors with confirmed syphilis infection in the UK and Ireland between 2016 and 2019 (1.6 per 100 000 donations). 42% of them (133 of 316) were classed as a recent infection based on their donation testing results, previous donation date and clinical history provided, and they were hence considered potentially infectious. Most of these blood donors (202 of 316, 64%) had not been previously diagnosed or treated for syphilis, although 50 of them reported symptoms consistent with syphilis infection and 19 had been misdiagnosed despite seeking medical help.

Conclusions This observational study shows that syphilis infection remains undiagnosed, especially among heterosexual men, and that infectious syphilis is often missed as a differential diagnosis even when donors have presented with genital or oral ulceration, rashes in the genital area and lymphadenopathy. Considering the recent resurgence of syphilis infections in the UK and beyond and our generally expanding sexual networks, it is important to consider syphilis in differential diagnosis even if specific risk factors have not been identified.

  • syphilis
  • risk factors
  • medical history taking
  • general practice

Data availability statement

Data are available upon reasonable request. All data relevant to the study are included in the article or uploaded as supplementary information.

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Data availability statement

Data are available upon reasonable request. All data relevant to the study are included in the article or uploaded as supplementary information.

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  • Handling editor Francesca Ceccherini-Silberstein

  • Twitter @HarvalaHeli

  • Contributors HH drafted the initial plan to this study, which was then discussed and agreed with CR, AF, JT, GB, SBr, SBl and LP. Each coauthor helped to draft the first version of the manuscript, which was then finalised by HH. CR pulled together the epidemiological data. GB, AF, SBl and HH analysed the clinical donor data. All authors have seen and approved the final version of this manuscript.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.