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.

III.

Abortions by dilatation and evacuation after the 12th menstrual week of pregnancy are said to be both hazardous and impractical. To evaluate this hypothesis, we compared the safety and feasibility of 6213 abortions by this means and 8662 induced by intra-amniotic instillation of saline during the 13th to the 20th week of pregnancy. Abortions by dilatation and evacuation had a lower rate for major complica-tions (0.69 vs. 1.78 per cent; P is less than 0.001) and lower rates for treatment of complications, including antibiotic administration (2.22 vs. 5.65 per cent; P is less than 0.001), blood transfusion (0.19 vs. 0.91 per cent; P is less than 0.001), and curettage or manual evacuation of the uterus (0.98 vs. 34.10 per cent; P is less than 0.001). Such abortions also had a lower rate for failure of the method to produced abortion (0.11 vs. 2.52 per cent; P is less than 0.001). Although large, randomized trials are required to determine the appropriate role of mid-trimester abortion by this means, this method appears safe and practical through the 20th week of pregnancy.

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