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Dermatologists infrequently diagnose syphilis

Although the incidence of syphilis has been rising in the United States, dermatologists may infrequently diagnose the disease, according to a retrospective review of cases in Rhode Island published in JAMA Dermatology.

“In 2015, the Rhode Island Department of Health reported that the number of statewide cases of syphilis had increased by 79% from prior years,” Jack. P. Cossman, MD, and John B. Fournier, MD, of the department of dermatology at Roger Williams Medical Center, Boston University School of Medicine, Providence, Rhode Island, wrote. “In fact, nationwide, the incidence of syphilis has been rising alarmingly in the 21st century, prompting the U.S. Preventive Services Task Force to update screening recommendations in 2016. … While historically syphilology was a major focus of dermatology, it is unclear who primarily diagnoses syphilis in the modern era.”

Cossman and Fournier performed a retrospective review of 364 syphilis cases (average age, 35.8 years; 62.9% white) reported between 2010 and 2014 to the Rhode Island Department of Health. Patients who experienced reinfection were excluded from the review.

Males made up most of the cases (92%), and men who have sex with men (MSM) were the most prevalent (74.7%). The majority of patients were HIV-negative (57.7%), and 12.9% of statuses were unknown. Among MSM with syphilis, 36% were HIV-positive, compared with 29.3% of cases overall.

Patients were most frequently seen by primary care or community health care clinicians (35.4%), followed by infectious disease specialists (25.5%), urgent or emergency care (18.1%) and STI clinics (11.3%). Dermatologists diagnosed nine patients (2.5%), including seven with an erythematous eruption and two with a genital lesion.

The researchers noted that a possible reason that dermatologists infrequently diagnose syphilis is that other clinician options might be easily accessible for STI testing, and that patients at high risk for STIs, including HIV-positive MSM, are often being cared for by an infectious disease specialist.

“Where syphilis once was a disease studied intently and diagnosed clinically by dermatologists, other clinicians began to assume the responsibility when methods of laboratory diagnosis evolved and awareness grew that syphilis is ‘less and less a cutaneous disease,’ the researchers wrote. “Our findings … highlight an opportunity for dermatologists to become reengaged, particularly with the resurgence of cases. Maintaining acuity to consider syphilis clinically or offering screening to asymptomatic individuals who are at risk, dermatologists can substantially contribute to the control and elimination of syphilis.”– by Bruce Thiel

Disclosure: The researchers report no relevant financial disclosures.