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the Government of Western Australia, Department of Health.
Western Australia is experiencing an ongoing outbreak of infectious syphilis. We need to work together across all sectors of primary care and tertiary health services to halt this outbreak and ensure better health outcomes for everyone.
Dr Belinda Wozencroft, a general practitioner with special interests in women’s health, sexual health and HIV medicine, says infectious syphilis has re-emerged as a significant public health threat over the past decade.
“Infectious syphilis is a notifiable sexually transmitted infection (STI) and has significant health implications due to the risk of congenital syphilis. Tertiary syphilis, whilst considered rare, can cause dementia, blindness, hearing loss and cardiovascular issues, any of which is significant for the affected individual.
“However, it is congenital syphilis which really needs to be the current focus.
“Congenital syphilis occurs when syphilis is transmitted from an untreated mother in-utero to her child. It can result in stillbirth, premature labour and significant short and long-term health issues for the child. If detected and appropriately managed with a course of LA Bicillin for treatment and follow-up during pregnancy, the outcomes for the child can be significantly improved.
“Of significant concern, are pregnant women and women of reproductive age. The number of infectious syphilis notifications increased drastically from 11 notifications in 2014, to 271 notifications in 2022.
“Over the same time period, the number of notifications among Aboriginal females of reproductive age increased by almost 18-fold. With the rise in notifications in women of reproductive age, there has also been a significant increase in congenital syphilis notifications. From 2014 to 2022, there were 14 congenital syphilis cases in WA. Of those 14 cases, five resulted in stillbirth or death.”
Infectious syphilis testing recommendations
To assist with the detection of infectious syphilis in pregnancy, the Western Australian Department of Health recommends three tests for all pregnant women at:
- booking
- 28 weeks
- 36 weeks (or at birth if earlier than 36 weeks).
Five syphilis tests during and after pregnancy are still recommended in the Kimberley, Pilbara and Goldfields regions, due to the high rates of infectious syphilis in those regions.
In addition, screen for syphilis if there are symptoms of concern which include a non-specific rash or an ulcer (at both genital and extra-genital sites). Maintain a high index of suspicion for any ulcer, and check the ulcer with a syphilis PCR swab as well as syphilis serology. If another STI has been identified, remember to follow-up with blood-borne virus serology including syphilis serology.
What can GPs do?
- Offer syphilis testing to all pregnant women. Testing at three time points in pregnancy can assist with early detection and treatment. Importantly, follow-up with women who did not attend for testing, or, if the pathology provider did not complete the test.
- Offer opportunistic tests to all people aged 16-45 years. The Department of Health is relaunching the ‘Healthysexual’ campaign which encourages people to get a syphilis blood test. Patients usually respond positively to being offered a test in response to a campaign or public health program. Visit healthysexual.com.au for more information.
- Get informed about testing and treatment. The Department of Health ‘Silverbook’ provides detailed information on testing and treatment for syphilis at health.wa.gov.au/silverbook
- Get extra training. There are a range of training opportunities for general practitioners to test, treat and manage syphilis and other STIs on the ASHM website at
ashm.org.au - Need some help? If you have questions about syphilis, contact the public health unit in your area.
- Promote sexual health in your practice. The Department of Health offers free health promotion materials, that can be ordered from doh.getquickmail.com
Questions? Contact the editor.
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