Incidence of secondary syphilis on rise & need for a separate flow chart for its syndromic management
Kar, H.K.
Indian Journal of Sexually Transmitted Diseases 25(2): 70-73
2004
ISSN/ISBN: 0253-7184 Document Number: 254223
The incidence of secondary syphilis as compared to primary syphilis is reported to be higher in different regions of India. However, it escapes the conventional syndromic management of STDs. Secondary syphilis presents with non-itchy bilateral skin rash with past history of sexual contact and of genital ulcer. A retrospective study was conducted to find out the trend in incidence of primary and secondary syphilis during the last 8 years (1995 to 2002) in an urban STD clinic attached to the dermatology department of a tertiary care hospital in Delhi and to explore the need for a separate flow chart for secondary syphilis. Data were analysed with respect to type of STDs and different stages of syphilis. The diagnosis of syphilis was based on clinical parameters, DG microscopy, VDRL test and TPHA test. There was a decrease in incidence of primary syphilis manifested as genital ulcer from 6.5% in 1995 to 2.9% in 2002 except with a higher peak in 1998 and 1999 (8.5% and 8.1%, respectively) out of a total of 3132 STD patients over the last 8 years. The incidence of secondary syphilis showed an increasing trend (5.1% in 1995 to 9.7% in 2002 with a peak of 10.1% in 1999). However, the increasing trend in secondary syphilis and decreasing trend in primary syphilis were not statistically significant (P=0.18089 and P=0.16849 respectively by chi 2 test). Out of 274 secondary syphilis cases, 66.6% never took any treatment and 33.3% took inappropriate treatment at primary chancre stage. Non-itchy skin rash with or without mucous membrane lesions/lymph node enlargement was the major clinical presentation found in 94.4% of cases of secondary syphilis. In 3.6% of cases of secondary syphilis, condyloma acuminata was the only clinical presentation. Results show that secondary syphilis incidence is on the rise. This information requires further confirmation from other parts of India. There may be a need for an 8th flow-chart for bilateral, non-itchy, non-vesicular skin rash with past history of sexual contact and genital ulcer, for the syndromic management of secondary syphilis. The proposed flow chart for secondary syphilis is presented and requires validation.