Audit of the management of the syphilis outbreak in Herefordshire 2011-2013.

The objective of this audit was to evaluate a localised rural outbreak of syphilis against British Association of Sexual Health and HIV guidelines. Forty-nine cases were identified; 98% were men, and 88% were men who have sex with men (MSM). There was a low incidence of HIV co-infection (18%). All standards regarding monitoring and treatment were met, whereas the standard concerning contact tracing was narrowly missed, highlighting a number of issues and areas for improvement. This audit has highlighted that a proactive approach is necessary to identify cases of syphilis in rural communities. This is due to difficulties in outreach testing and contact tracing in the absence of designated meeting places for MSM.