The objective of this study was to identify the demographic characteristics and sexual behaviour associated with primary, secondary and early latent syphilis in Birmingham and its epidemiologic and public health implications. All new patients diagnosed as having infectious syphilis in a genitourinary service in Birmingham in the period from January 2005 to December 2005 were studied retrospectively (history, physical examination, serology) to determine the stage of their disease. During the 12-month period, 69 new cases of primary, secondary and early latent syphilis were diagnosed. Patients were most commonly male (96%), aged between 20 and 44 years, symptomatic (84%) and were white men who had sex with men or Asian/Black Caribbean heterosexual men. Unemployment and having multiple partners were common in infected patients. Based on the results of this study, control measures are being undertaken, using enhanced surveillance, to focus on appropriate health promotion initiatives.