There has been a recent increase in the incidence of infectious syphilis in the UK, especially in homosexual men. Dark ground microscopy (DGM) provides immediate diagnosis but requires a dark field microscope and trained staff and, because syphilis has been uncommon in the UK until recently, many genitourinary medicine physicians are unskilled in its use. Other direct detection methods such as direct fluorescent antibody staining (DFA-Tp) or polymerase chain reaction (PCR) are more difficult or slow and serological tests have limited sensitivity for primary syphilis. Workers in London have confirmed …