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Objectives: Syphilis outbreaks have recently been reported in the United Kingdom, some of which have included cohorts of HIV positive individuals. As a result we commenced 3 monthly screening of syphilis serology (STS) for HIV positive patients having routine follow up blood tests. We assessed if there was an increased number of individuals being screened and also whether the screening programme was diagnosing early cases of syphilis. Methods: Data from a 1 year period following introduction of screening (May 2001) were analysed and compared with data from the same period last year. The case notes of patients with a positive VDRL were reviewed to establish, firstly, whether these represented new diagnoses and, secondly, whether patients were asymptomatic at the time of screening. Results: 2670 patients had at least one CD4 count measured in the period (surrogate for patients having routine bloods). Of these, 2266 patients had STS performed (85%). 38 patients had a positive VDRL. Of these, 20 were confirmed as having early syphilis which was asymptomatic at the time of screening. Six asymptomatic cases were also confirmed with newly positive TPPAs and a negative VDRL. These 26 asymptomatic cases represent 29% of all cases of early syphilis diagnosed in our department and 50% of cases in the HIV positive cohort. Conclusion: With intensive surveillance significant numbers of cases of asymptomatic early syphilis are being identified in a group of HIV individuals under routine follow up, at an earlier stage than would otherwise have been the case. This presents an opportunity to intervene not only to prevent clinical illness but also to institute infection control measures. I n the United Kingdom between 1996 and 2001, new diagnoses of infectious syphilis more than quadrupled from 122 cases to 715 cases.1 This was largely due to a number of outbreaks predominantly in men who have sex with men (MSM) and were reported in Manchester and in the south east of England (Brighton and London areas).2 The outbreaks included high numbers of HIV infected individuals.In the monitoring of HIV infected individuals it has been recently recommended to perform syphilis serology 6 monthly.3 This screens both for recrudescence in those previously treated for syphilis and also for new infections. However in the context of a syphilis outbreak we felt increasing the frequency of monitoring to 3 monthly would potentially have two additional benefits. Firstly, testing syphilis serology at the time of regular HIV follow up visits would make this more routine and hence we would screen the population more effectively. Secondly, cases would likely be identified earlier and with treatment instituted, the period of infectivity consequently reduced. This would have a positive impact on one of the drivers of outbreaks.As a result of these arguments, routine screening for syphilis was increased from yearly to 3 monthly in May 2001. The objectives of this study are to assess if there was an increase in the number of individuals being screened and als...