Press release

PHE publishes report on syphilis

PHE reminds Londoners to practice safe sex as rates of syphilis are 3 times higher in the capital than anywhere else in England.


A new syphilis report released today (17 August 2016) by Public Health England (PHE) shows that the rate of syphilis diagnoses is 3 times higher among Londoners than anywhere else in England. In 2015, nearly 3,000 cases were diagnosed in the capital, accounting for 56% of all cases in England (5,042).

Syphilis, like other sexually transmitted infections (STIs), is transmitted through sexual activity including oral sex. Most cases of syphilis are treatable with antibiotics and it is preventable through safe sex practices which include using condoms, regularly being tested and avoiding overlapping sexual relationships.

With cases of syphilis continuing to increase in recent years (since 2010, cases among Londoners have soared by 163%) PHE is raising awareness of syphilis and reminding Londoners to practice safe sex, which prevents infection.

Syphilis has been diagnosed in all 33 London local authorities and in 2015 most saw an increase in numbers. Cases of syphilis have been reported among heterosexuals and men who have sex with men (MSM). However, MSM are disproportionately affected by the infection. Despite representing around 2% of the London population, in 2015 MSM made up 90% of all syphilis cases. This group has seen an 18% increase in cases from 2014 to 2015 alone.

This continued rise in syphilis cases in the capital suggests that too many Londoners are putting themselves at risk through unsafe sex.

Although most cases of syphilis are treatable with antibiotics, people can be infected and not show any symptoms for years; treatment is more effective the earlier syphilis is diagnosed and so more awareness is needed around the infection.

Syphilis progresses through 3 main stages:

  1. Primary syphilis infection will often present about 3 to 4 weeks after someone has been infected with the bacteria and individuals may develop a painless ulcer or rash (lasting for 3 to 6 weeks) on the genitals, rectum or inside the mouth, which people can fail to notice straight away.
  2. Secondary stage causes fever, headaches and night sweats (among others).
  3. Latent and late stage syphilis; if left untreated it can progress into this stage of the STI which is characterised by more serious and damaging health complications including cardiovascular problems and central nervous disease; it can even be fatal.

Dr Yvonne Doyle, regional director for PHE London, said:

Worsening sexual health remains one of the biggest public health concerns facing London and it is worrying to see such alarming rises in syphilis year-on-year. Most cases of syphilis are treatable with antibiotics and it is preventable if you practice safe sex.

We are seeing large increases in cases of syphilis among men who have sex with men and they now represent 90% of syphilis cases in London. Although diagnoses among heterosexuals in the capital are more stable they too continue to be higher than we would like given the effective preventative measures in place.

In London, we have excellent open access sexual health services providing free STI testing and treatment, notification for the sexual partners of those diagnosed with an STI and free provision of contraception. With these services available across the capital there is no reason for people to be taking unnecessary risks with their sexual health.

I hope today’s report will further raise awareness of sexually transmitted infections including syphilis and drive home the messages about the importance of practising safe sex, which includes using condoms, regularly being tested and avoiding overlapping sexual relationships. All of these will reduce the risk of STIs.

Improving the sexual health of Londoners is a priority area for PHE London and we will continue to work with partners across the healthcare system to reduce the burden of poor sexual health in the capital.

Dr Patrick French, a sexual health specialist and genitourinary medicine consultant at Central and North West London NHS Foundation Trust, said:

When I started working in sexual health in London we might have diagnosed 4 or 5 people with syphilis in a year; we can now see that number of people with syphilis in a day or 2.

Syphilis has established itself as a major problem in London among men who have sex with men, but there is now a considerably smaller but worrying rise among heterosexuals.

The increase we are seeing in syphilis and other sexually transmitted infections is a marker of a more general problem within sexual health and tackling this must be a priority across London. More awareness is needed around STIs, how they can be prevented and why it is important to have a check-up if you think you are at risk. Anyone having sex with new or casual partners should always use condoms and have regular sexual health checks.

PHE recommendations for safe sex

Anyone who suspects they may have syphilis should get screened at their local sexual health clinic as soon as possible.

Consistent and correct condom use, reducing the number of sexual partners and the avoidance of overlapping sexual relationships all reduce the risk of acquiring STIs.

For people in the highest risk groups, getting screened regularly will lead to early diagnosis and treatment, which is vital as some STIs can be symptomless.

PHE recommendations for safe sex among men who have sex with men (MSM)

Have an HIV and STI screen at least annually; every 3 months if you are having unprotected sex with casual or new sexual partners.

Always use a condom correctly and consistently, and until all partners have had a sexual health screen.

Reduce the number of sexual partners and avoid overlapping sexual relationships.

Unprotected sex with partners believed to be of the same HIV status (serosorting) is unsafe. For the HIV positive person, there is a high risk of acquiring other STIs and hepatitis. For the HIV negative person, there is a high risk of acquiring HIV infection as well as acquiring STIs and hepatitis.


  1. Public Health England exists to protect and improve the nation’s health and wellbeing, and reduce health inequalities. It does this through world-class science, knowledge and intelligence, advocacy, partnerships and the delivery of specialist public health services. PHE is an operationally autonomous executive agency of the Department of Health. Follow us on Twitter: @PHE_uk and Facebook:
  2. There were 2,811 cases of syphilis diagnosed in Londoners in 2015, representing 56% of all cases in England (5,042).
  3. Of these 2,811 cases, 2,406 cases were diagnosed in MSM (90% of all syphilis cases in London for whom sexual orientation was reported).
  4. Cases of syphilis diagnosed among the capital’s residents rose by 22% year-on-year between 2014 and 2015 alone.
  5. In 2015, London boroughs made up 18 of the top 20 local authorities in England with the highest rates of syphilis.
  6. The median age of MSM diagnosed with syphilis in 2015 was 36 years old. In total, 74% were white and 44% were born in the UK.
  7. Syphilis epidemiology in London is available online.
  8. The information presented here represents those who live in London as opposed to those diagnosed in London.
  9. For more information on syphilis you can visit NHS Choices.
Published 17 August 2016