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To the Editor: In his Contempo Updates article about genital lesions, Dr Rosen¹ did not fully discuss syphilis. Large numbers of cases of syphilis, however, are now occurring among men who have sex with men.² This is of concern because infectious syphilis facilitates human immunodeficiency virus (HIV) transmission,³ and many men diagnosed with syphilis are also infected with HIV.⁴ In addition, there is concern that syphilis will spread to heterosexual populations that in the recent past have had outbreaks of syphilis.⁴ Early diagnosis and treatment of primary syphilis can prevent transmission of syphilis and very likely decrease the risk of HIV transmission.³

We urge clinicians caring for patients who are at risk for sexually transmitted diseases to consider primary syphilis in the differential diagnoses of a genital ulcer.⁵ Clinicians can help control the spread of syphilis by discussing with their patients the importance of cooperating with health department investigators so . . . [Full Text of this Article]

Robert A. Gunn, MD, MPH; Thomas A. Peterman, MD, MSc; Kimberly A. Workowski, MD
Division of STD Prevention
National Center for HIV, STD, TB Prevention
Centers for Disease Control and Prevention
Atlanta, Ga

RELATED ARTICLE

Update on Genital Lesions
Ted Rosen
JAMA. 2003;290(8):1001-1005.
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