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An ongoing infectious syphilis outbreak has spread across Australia’s states and territories leading to an endemic level in some areas. The outbreak was first reported among Aboriginal and Torres Strait Islander people in rural and remote northern Australia in 2011. Clinicians are now encouraged to have a high clinical suspicion for syphilis in all population groups.
Notifications on the rise in South Australia
Syphilis notifications are now increasing throughout the NT, QLD, WA and SA with cases notified in Adelaide, the Goldfields region of WA and Central Queensland. Recent South Australian data has shown an increase among non-Aboriginal and heterosexual populations.
What is syphilis?
Syphilis is a bacterial infection which is transmitted through sexual activity and during pregnancy to an unborn baby. There are 4 stages of syphilis known as primary, secondary, latent and tertiary.
Primary syphilis may present as a painless genital ulcer called a chancre. It is usually singular, painless and has a well-defined margin. It is possible for a chancre to go unnoticed, especially if present on the roof of the mouth, the cervix or on anal skin. This ulcer will spontaneously heal within a few weeks, but the person will remain infectious.
If syphilis is not diagnosed at this stage, the infection will then progress to secondary syphilis a few weeks later. The usual presentation is a body rash that will specifically affect the palms of the hands and soles of the feet. There may be other symptoms such as fever, malaise, lymphadenopathy, headache or alopecia. The rash can be easily mistaken as other conditions such as drug eruptions, pityriasis rosea or guttate psoriasis and if untreated will resolve, although it can sometimes recur.
The following 2 years is the early latent stage. This is where there is an absence of symptoms, but the person is still infectious. After 2 years the infection is in the late latent stage. People are no longer able to pass syphilis to their sexual partners, but it is still possible to pass the infection to an unborn baby during pregnancy.
The final stage is tertiary syphilis. This can develop months or years later in approximately 1/3 of all cases. Symptoms can include severe skin lesions called gummas, ophthalmic, cardiovascular and neurological disease. This stage is prevented by treatment; therefore screening is essential.
Increased testing is needed
In response to rising cases, a South Australian public health alert was issued in November 2021. The health alert recommends an increase in testing among all population groups.
Clinicians are advised to maintain a high clinical suspicion for syphilis and to offer syphilis screening to all asymptomatic sexually active patients as part of a regular sexual health checkup. Also, to include syphilis testing where other STIs such as chlamydia, gonorrhea and HIV have been diagnosed, including contacts.
Syphilis screening of all pregnant people should occur at the first antenatal visit, with repeat screening throughout pregnancy indicated for those at higher risk. Vertical transmission in pregnancy is a major concern as congenital syphilis can cause still birth, neonatal death, preterm delivery, low birth weight and developmental abnormalities.
When there is a positive result, prompt treatment should include the patient and their sexual partner/s) All cases should be notified and follow up testing should occur at 3, 6 and 12 months to monitor treatment response and exclude reinfection.
Further resources
For more information for health professionals including Fact Sheets, video resources and more visit: www.shinesa.org.au/syphilisoutbreak/
The South Australian Health and Medical Research Institute (SAHMRI) has also delivered a multi-strategised Aboriginal and Torres Strait Islander Community awareness and education campaign in response to the syphilis outbreak. The Young, Deadly, Free website offers a range of resources for young people in remote Aboriginal Communities, resources for Elders, parents and clinicians. For more information visit: https://youngdeadlyfree.org.au/
Syphilis – Australian STI Management Guidelines
