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Syphilis is caused by the spirochete bacterium Treponema pallidum and can be transmitted both sexually and from mother to child. T pallidum can infect any organ and produces a clinical disease with a relapsing and remitting course. It is not hard to see, therefore, why it is often described as the great mimic. In this review, we provide an update of modern syphilis epidemiology, clinical presentations, and testing and treatment strategies.

Objectives The 2008 UK National Guidelines for HIV testing recommended HIV testing should be offered to all general medical admissions aged 16–60 years in high prevalence areas, and that this should be evaluated to ensure this was effective in diagnosing previously undiagnosed HIV. Methods HIV testing was introduced as a routine test for all patients admitted to the acute medical admissions unit, comparisons were made between the testing rates before, during and after this intervention. Results The pilot was initiated in August 2009. Prior to the pilot the unit was carrying out 15 tests per month. However, when the pilot was introduced 82 tests were being carried out per month with a total of 10 new diagnoses since the start of the pilot. The proportion of patients tested versus those eligible for testing remained low varying between 6% and 22% month by month. 10 patients we found to be HIV positive with a prevalence of approximately 1%, 10 fold higher than the cut off for cost effectiveness used in the guidelines. Conclusions Overall the pilot showed that HIV testing could be delivered without the use of extra resources and is acceptable to patients.

Lichen Sclerosus is a chronic inflammatory skin disorder. In men it presents mainly on the prepuce, coronal sulcus and glans penis. The cause of lichen sclerosus is not fully understood, but genetic and autoimmune factors are thought to be important. Infections have been investigated as a cause, but with no clear evidence of a potential causative agent. In men the association with autoimmune diseases is weaker; however studies have shown a family history of diabetes mellitus, and thyroid disease are possible risk factors. Other suggested potential causes are chronic intermittent damage by urine, as early circumcision seems to be preventative in those who do not have congenital anomalies such as hypospadias. Recommended treatments include circumcision and potent topical steroid ointments. Taking this into consideration we reviewed notes of patients that presented to the monthly Joint Dermatology clinic with a diagnosis of lichen sclerosus to ascertain the number of recurrences post circumcision. We found four cases of recurrence of lichen sclerosus in patients attending the clinic over a four month period. Ages varied between 39–81 years old. One patient had diabetes mellitus, and another had been circumcised twice. All patients needed treatment with potent topical steroid ointment. Lipscombe et al . stated that 50% of patients who had a circumcision had a recurrence. It is important when discussing management with patients to remember that lichen sclerosus can recur after circumcision. From our observations, the presence of folds of skin still covering the glans penis best predicts recurrence.

Background Patients at increased risk of STI/HIV acquisition are advised to re-attend for re-testing. A previous study showed that ‘generic’ text reminders did not improve re-attendance. Aim To assess if a personalised text message would increase re- attendance rates of at risk patients who require repeat STI testing. Methods At-risk patients were sent a text reminder to re-attend for re-testing 6 weeks after their initial visit. They were considered to be ‘at risk’ if they had an acute STI or had attended for emergency contraception at the initial visit, or were MSM. Re-attendance rates were measured for September to December 2012 (control group who received a generic text message advising re-attendance) and February to May 2014 (personalised message group who received a text message containing their first name and several different ways to contact the clinic). Re-attendance was counted within four months of the end of the initial episode of care. Results The re-attendance rate was significantly higher for the personalised message group (144/266(54%) than the control group: (90/273 (33%) (P = 0.0001) and was also significantly higher in the personalised message group than the control group in patients with the following risks: recent chlamydia (61/123(50%) vs (43/121(36%) (P = 0.03), recent gonorrhoea (42/64(66%) vs (4/21(19%) (P = 0.0003) and MSM (25/45(56%) vs (3/18(16%) (P = 0.006). New STI rates in the re-attending ‘personalised message’ group and controls were 26/144(18%) and 13/90 (14%) (n.s) respectively. Conclusion Sending a personalised text message as a reminder for re-testing increases re-attendance rates in patients who are at higher risk of STIs.