HIV-positive patients: Treat as appropriate for stage of infection, that is, HIV-positive patients are treated with the same regimens as HIV-negative patients † Management of sexual partners: Recognition that partner notification may be difficult in context of current syphilis outbreaks and achieving 60% partner notification rates is not always possible and screening in high-risk venues may be appropriate. † Auditable outcomes: Measuring rapid plasma reagin test (RPR)/Venereal Diseases Research Laboratory (VDRL) at commencement of therapy introduced as an auditable outcome. † Appendices:-Reference to sources of procaine penicillin G-Use of lidocaine as diluent for Benzathine penicillin G DIAGNOSIS History and examination † Symptoms of early syphilis † Details of previous treatment (place of treatment, diagnosis made, treatment given, RPR/VDRL titre at discharge) † Obstetric history, potential complications of syphilis e.g. miscarriages, stillbirths † Blood donation and antenatal screening history † Other treponemal infections; yaws, pinta and a history of living in countries where these conditions are endemic † In early infection examination of the genitals, skin, mucosal surfaces and lymph nodes for signs of primary and secondary syphilis. † In late and congenital syphilis a thorough clinical examination should be undertaken for the clinical manifestations of syphilis. This should include a full systems review including skin and mucosal surfaces, lymph nodes, cardiovascular and neurological systems.

This study is the largest prospective series of ocular syphilis in the post-penicillin era. It confirms good visual outcomes for treated IOS, irrespective of HIV status or time to presentation. The study identified an unexpected preponderance for left eye involvement in uniocular cases; which is unexplained.

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