Primary syphilis in men causes painful anogenital lesions and serology is not always helpful

There has been an increase in infectious syphilis in Australia.1 The diagnosis of primary syphilis is by dark field microscopy, PCR testing or serological testing; however, serology may be negative in early syphilis.2 3 With the loss of our ability to perform dark field microscopy, patients are either treated empirically or await the results of molecular and/or serological testing for confirmation of Treponema pallidum infection. We aimed to determine whether the proportion of patients with primary syphilis were treated empirically and, if treatment was delayed, how long patients had to wait for treatment and what proportion of patients with primary syphilis had negative serology at time of presentation. We reviewed clinical notes of patients who presented with anogenital lesions and had …