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  1. Right Decisions
  2. DGRefHelp - NHS Dumfries & Galloway
  3. Sexual health
  4. Sexually transmitted infections (STIs)
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  6. Syphilis
  7. Introduction
Important: please update your RDS app to version 4.7.3 Details with newsletter below.

Please update your RDS app to v4.7.3

We asked you in January to update to v4.7.2.  After the deployment planned for 27th February, this new update will be needed to ensure that you are able to download RDS toolkits even when the RDS website is not available. We will wait until as many users as possible have downloaded the new version before switching off the old system for app downloads and moving entirely to the new approach.

To check your current RDS version, click on the three dots bottom right of the RDS app screen. This takes you to a “More” page where you will see the version number. 

To update to the latest release:

 On iPhones – go to the Apple store, click on your profile icon top right, scroll down to see the apps waiting to be updated and update the RDS app.

On Android phones – these can vary, but try going to the Google Play store, click on your profile icon top right, click on “Manage apps and device”, select and update the RDS app.

Right Decision Service newsletter: February 2025

Welcome to the February 2025 update from the RDS team

1.     Next release of RDS

 

A new release of RDS is planned (subject to outcomes of current testing) for week beginning 24th February. This will deliver:

 

  • Fixes to mitigate the recurring glitches with the RDS admin area and the occasional brief user interface outages which have arisen following implementation of the new distributed technology infrastructure in December 2024.

 

  • Capability to embed content from Google calendar, Google Maps, Daily Motion, Twitter feeds, Microsoft Stream into RDS pages.

 

  • Capability to include simple multiplication in RDS calculators.

 

The release will also incorporate a number of small fixes, including:

  • Exporting of form within Medicines Sick Day Guidance in polypharmacy toolkit
  • Links to redundant content appearing in search in some RDS toolkits
  • Inclusion of accordion headers alongside accordion text in search result snippets.
  • Feedback form on mobile app.
  • Internal links on mobile app version of benzo tapering tool

 

We will let you know when the date and time for the new release are confirmed.

 

2.     New RDS developments

There is now the capability to publish toolkits on the web with left hand side navigation rather than tiles on the homepage. To use this feature, turn on the “Toggle navigation panel” option at the top of the Page settings menu at toolkit homepage level – see below. Please note that publication to downloadable mobile app for this type of navigation is still under development.

The Benzodiazepine tapering tool is now available as part of the RDS toolkit for the national benzodiazepine prescribing guidance developed by the Scottish Government Effective Prescribing team. The tool uses this national guidance developed with a wide-ranging multidisciplinary group. This should be used in combination with professional judgement and an understanding of the needs of the individual patient.

3.     Archiving and version control and new RDS Search and Browse interface

Due to the intensive work Tactuum has had to undertake on the new technology infrastructure has pushed back the delivery dates again and some new requirements have come out of the recent user acceptance testing. It now looks likely to be an April release for the search and browse interface. The archiving and version control functionality may be released earlier. We’ll keep you posted.

4.     Statistics

At the end of January, Olivia completed the generation of the latest set of usage statistics for all RDS toolkits. If you would like a copy of the stats for your toolkit, please contact Olivia.graham@nhs.scot .

 

5.     Review of content past its review date

We have now generated reports of all RDS toolkit content that has exceeded its review date by 6 months or more. We will be in touch later this month with toolkit owners and editors to agree the plan for updating or withdrawing out of date content.

 

6.     Toolkits in development

Some important toolkits in development by the RDS team include:

  • National CVD prevention pathways – due for release end of March 2025.
  • National respiratory pathways, optimal cancer diagnostic pathways and cancer prehabilitation pathways from the Centre for Sustainable Delivery. We will shortly start work on the national cancer referral pathways, first version due for release via RDS around end of June 2025.
  • HIS Quality of Care Review toolkit – currently in final stages of quality assurance.

 

The RDS team and other information scientists in HIS have also been producing evidence summaries for the Scottish Government Realistic Medicine team, to inform development of national guidance around Procedures of Limited Clinical Value. This guidance will in due course be translated into an RDS toolkit.

 

7. Training sessions for new editors (also serve as refresher sessions for existing editors) will take place on the following dates:

  • Friday 28th February 12-1 pm
  • Tuesday 11th March 4-5 pm

 

To book a place, please contact Olivia.graham@nhs.scot, providing your name, organisation, job role, and level of experience with RDS editing (none, a little, moderate, extensive.)

 

To invite colleagues to sign up to receive this newsletter, please signpost them to the registration form  - also available in End-user and Provider sections of the RDS Learning and Support area.   If you have any questions about the content of this newsletter, please contact his.decisionsupport@nhs.scot  If you would prefer not to receive future newsletters, please email Olivia.graham@nhs.scot and ask to be removed from the circulation list.

With kind regards

 

Right Decision Service team

Healthcare Improvement Scotland

 

 

Introduction

All patients diagnosed with Syphilis should be given a detailed explanation of their condition and this should be reinforced with the offer of written information.

Syphilis in Pregnancy
Refer to BASHH Guideline on Syphilis (beyond the scope of this document)

History taking and Surveillance
Major outbreaks of syphilis (mostly in MSM) have been reported in London, Manchester, Brighton and Dublin as well as Glasgow and Edinburgh. Ask about sex in scene venues (saunas, back rooms) and geographical location of sex partners. Record this location in the notes.

There have also been recent outbreaks of syphilis affecting young heterosexual males and females in Scotland.

A national surveillance scheme exists for all early infectious syphilis. This uses laboratory data and clinician-initiated reports. Each clinic should be aware who completes these forms in their area. These forms should be completed proactively. Completion of this form should be recorded in the patient clinical notes.

Clinical and laboratory assessment:

  • Testing for Syphilis always involves blood tests. In addition if there are suspicious lesions then dark ground microscopy and PCR should be performed where possible (see under primary syphilis).
  • Blood tests for syphilis are either known as ‘Treponemal’ or ‘non-treponemal’
    tests for syphilis:
    • Treponemal tests include TPPA, Treponemal total antibody EIA and Inno-LIA. These should not be used to assess disease activity and remain positive for life in most patients.
    • Non-treponemal tests include VDRL and RPR and are quantitative. They are important for monitoring response to treatment and possible reinfection.
  • The initial screening test is a Treponemal total antibody EIA. If the screening test is found to be positive, further tests will be required and requested. These may include VDRL/ RPR, TPPA, Inno-LIA blot and specific IgM. These tests may be done locally or sent to the regional virus laboratory, Glasgow Royal
    Infirmary or The Royal Infirmary of Edinburgh Microbiology/Virology Lab or Colindale.
  • Inno-LIA blot is recommended when the confirmatory test does not confirm the positive treponemal screening test result.
  • All positive tests should be repeated on a second specimen for confirmation
  • If syphilis is suspected clinically, indicate this clearly on the request form
  • Full clinical examination, with particular emphasis on the skin, genitals, lymph nodes and mucosa is essential in all patients found to have positive syphilis serology. Cardiovascular and neurological examination is required in late syphilis and in those with relevant symptoms.
  • HIV testing should be recommended to all patients diagnosed with syphilis.
  • A full STI screen should be recommended to all patients diagnosed with syphilis. In addition the need for Hepatitis B vaccination should be assessed.
  • It is important that on the very first day of of treatment (DAY 1 of treatment), VDRL/RPR titre is taken, allowing accurate assessment of response to treatment. It is also important to ensure that when assessing response to therapy, results being compared are from the same lab.

HIV infection and Syphilis

  • Serological tests for syphilis in patients with both syphilis and HIV are generally reliable although false negative tests and delayed appearance of sero-reactivity have been reported.
  • HIV infected patients with early syphilis may be more likely to develop multiple/ large or deeper genital ulcers.
  • HIV infected patients with early syphilis may have an increased risk of neurological involvement, unusual neurological manifestations, and higher rate of treatment failure.
  • HIV infected patients may have neurological abnormalities that may be difficult to differentiate from neurosyphilis. Limited case review data suggests higher risk of neurosyphilis in HIV+ if VDRL/RPR 1:32 or greater.
  • A lumbar puncture is recommended in all HIV positive patients with:
    • Serological treatment failure
    • Neurological or ophthalmological signs/ symptoms
    • VDRL/RPR 1:32 or greater at any stage
    • Consider in those with late syphilis and CD4<350
  • HIV infected patients may also be more likely to have rapid progression to gummatous syphilis
  • All HIV infected patients co-infected with syphilis should have the choice to have a neurosyphilis treatment course whatever their syphilis infection stage. The decision may involve their attitude to further complications, injection discomfort and the likely ease of follow up. These difficult treatment decisions must be made by a senior HIV-experienced doctor
  • HIV infected patients may have a slower rate of decline of VDRL/ RPR after treatment
  • HIV co-infected patients should be followed up for life with at least six monthly serology (consider 3-monthly in an outbreak situation)

Editorial Information

Last reviewed: 30/09/2022

Next review date: 30/09/2024

Author(s): West of Scotland Managed Clinical Network in Sexual Health Clinical Guidelines Group .

Version: 7.1

Approved By: West of Scotland Managed Clinical Network in Sexual Health