The importance of specific outbreaks in the overall increase of syphilis in the UK is shown when one compares the trend in London, the South East, the West Midlands, the North West and Scotland with the rest of the UK. Control of the outbreaks has led to a significant drop in reported cases in these areas, sufficient to cause a drop in overall incidence, whereas the incidence in the rest of the UK continued to rise.1

A similar pattern appears when comparing heterosexually and homosexually acquired cases in men and cases in women.1