Comment on CME Infectious diseases

Editor – The recommendations for testing for some sexually transmissible infections vary across the scenarios discussed in the CME Infectious diseases section of Clinical Medicine, volume 18, issue 2, April 2018.

HIV testing is recommended in pyrexia of unknown origin¹ and in acute meningitis² but for acute encephalitis, the advice is to establish ‘risk factors for HIV infection’.³ This may be problematic in an encephalopathic patient; even patients with intact sensoria may conceal (or be unaware of) risk factors for HIV. Encephalitis is a recognised complication of HIV seroconversion as well as advanced disease. For some years syphilis has been the fastest increasing sexually transmitted disease in the UK. No advice to test for syphilis is given even though neurological involvement, including meningitis, is a recognised complication in early and late disease. I wonder if recommendations for testing for these entities in these areas should be reconsidered?