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Public health

Syphilis up

Sir, a surprise recent case of primary syphilis diagnosed in our oral surgery department prompted me to research current infection rates. I was shocked to find that new diagnoses of syphilis have increased by 199% in the UK over the last ten years, with a rise from 2,646 new diagnoses in 2010, to 7,900 in 2019.1 Males constitute 90% of cases with the rates highest amongst men who have sex with men (MSM), and often have co-infection with HIV.2 Syphilis rates dropped dramatically in the 1980s after awareness of HIV and campaigns for safer sexual practices but started increasing in 1997 following a series of localised outbreaks.3 National data shows many STI rates are increasing including chlamydia, gonorrhoea and herpes,1 although thankfully HIV is still on the decline.4

This particular gentleman in his sixth decade presented with recurrent ulceration on the lower lip and tongue, presumed traumatic until biopsy showed prominent plasma cells, prompting serological testing for spirochaetal infection. The RDR and VDRL test was positive for syphilis, and suggestive of primary and active infection. The gentleman was referred to sexual health for treatment with IM benzathine penicillin and for full sexual history and partner notification.

Discussing sexual history as part of social history is not commonplace within our profession and in fact most feel uneasy discussing the subject with their patients. But with rates of STIs including syphilis increasing we should consider these as part of our differential diagnoses and perhaps more routinely enquire after sexual partners and practices. Following guidance from our sexual health colleagues we have now begun routinely including HIV testing as a screen for unexplained oral candida infection and oral ulceration.


  1. 1.

    Public Health England. STI diagnoses & rates in England by gender 2010-2019. Available at: (accessed December 2020).

  2. 2.

    Public Health England. STIs and screening for chlamydia in England, 2019: annual official statistics, data to end of December 2019. Available at: (accessed December 2020).

  3. 3.

    Righarts A, Simms I, Wallace L, Solomou M, Fenton K A. Syphilis surveillance and epidemiology in the United Kingdom. Euro Surveill 2004; 9: 21-25.

  4. 4.

    Public Health England. Trends in new HIV diagnoses and people receiving HIV-related care in the United Kingdom: data to the end of December 2019. Available at: (accessed December 2020).

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Correspondence to J. Winterburn.

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Winterburn, J. Syphilis up. Br Dent J 230, 5 (2021).

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