Background: Primary syphilis is frequently under-tested in clinical settings due to its protean presentation. China is experiencing a mass syphilis resurgence, but near elimination in the 1960s contributes to low medical community knowledge. This analysis assesses clinical performance of Chinese STI physicians using unannounced visits conducted by standardized “incognito” patients (SPs). Methods: Trained SPs presented standardized cases of classic post-primary syphilis to physicians who consented to receive visits but were not told when they would happen. SPs reported back key visit details including testing and physical exams performed by the physician. Logistic regression models identified predictors of performance metrics, adjusting for the HIV status and sexual orientation of the presented case. Results: 123 visits were conducted with 41 physicians in 17 primary care centers. Syphilis testing was recommended in 84.5% of visits and in 31.7% of visits physicians performed at least 2 of 5 recommended clinical indicators. Physicians were less likely to offer syphilis testing to patients with HIV whether they presented as MSM (OR, 0.06; 95% CI, 0.01-0.57) or as straight men (OR, 013; 95% CI, 0.03-0.61). Those working >40 hours a week were less likely to offer testing (OR, 0.3; 95% CI, 0.09-1.01) and those older than the median age were less likely to perform a thorough exam (OR, 0.34; 95% CI, 0.14-0.83). Conclusions: Our analysis found that Chinese STI physicians frequently test patients for syphilis but are less likely to conduct thorough physical examinations. The under-testing of patients with HIV exposes missed opportunities to address the HIV/syphilis syndemic. Future trainings must emphasize the public health importance of dual screening and address physician concerns about occupational HIV exposure.
Smith et al. (Tue,) studied this question.