Neglect of syphilis in hospitalized patients.

Of 9,375 inpatients consecutively discharged from a major university hospital during a six-month period, 2,912 (31%) had a serologic test for syphilis (STS) before or during hospitalization. Seventy-five patients (2.6%) had reactive serology, and further testing confirmed the diagnosis of syphilis in at least 56 patients (75%). Forty-seven (84%) of the 56 patients were aged 40 or more, and 32 (57%) were women; seven (12.5%) had a spinal tap. A history of venereal disease was recorded for only 20 patients (36%), and 16 had a positive history of venereal disease or exposure. Forty-three percent of patients with reactive serology, including those with a biologic false-positive reaction, had proper management, including treatment when indicated. Only 16 (28%) of the 56 patients with syphilis had evidence of adequate therapy either before, during, or after hospitalization. We conclude that STS is frequently omitted in the evaluation of hospitalized persons, and that even with evidence of positive serology, the diagnosis, proper interpretation, and therapy are often ignored.