Syphilis Is Still Out There – Information for Health Professionals

Syphilis is on the rise in South Australia

It’s essential that during this time we continue to test, treat, cure and notify partners.

Health professionals are now encouraged to have a high clinical suspicion for syphilis in all population groups.

Syphilis Key Points

  • Include syphilis screening as part of a routine STI screen

  • Maintain a high clinical suspicion for syphilis, symptoms of primary and secondary syphilis can include sores, ulcers, rashes, visual changes, hearing issues and alopecia

  • Prevent congenital syphilis risks by regular screening during pregnancy

  • Treatment, contact tracing and follow-up screening at 3, 6 and 12 months is essential to reducing the rates of syphilis infection.

What is Syphilis?

Syphilis is a sexually transmitted infection. It is caused by the spirochete bacterium, Treponema pallidum, subspecies pallidum that can cause serious health problems if left untreated. Syphilis is usually passed on during anal, oral or vaginal sex. It is transmitted through skin-to-skin contact with an infected area. There are four stages of syphilis infection: primary, secondary, latent and tertiary. Each of these stages present different symptoms.

Syphilis is highly infectious during the first two years of infection. Pregnant people can transmit syphilis to their babies, which can result in perinatal death, premature delivery, and congenital abnormalities. Since 2016, South Australia has had five cases of infectious syphilis in pregnant people, and there have been three cases of congenital syphilis. It’s important to know that syphilis also increases the risk of HIV transmission.

Despite the serious health problems associated with syphilis it can be easy to cure if treated early.

Therefore, it is essential that medical practitioners understand the importance of testing and treatment of syphilis as well as the partner/s of those with infectious syphilis.

Symptoms, Treatment and Management

Advice for Health Professionals

  • Primary syphilis may present with one or more typically painless ulcers at the site of infection.
  • Secondary syphilis may present with a rash and constitutional symptoms such as fever or malaise.
  • Be alert to new visual complaints and consider syphilis in the differential diagnosis. Ocular and neurological symptoms may occur at any stage of syphilis.
  • Take a dry swab of any potentially syphilitic lesion or rash for syphilis PCR, in addition to bloods for syphilis serology. Herpes simplex (HSV) swabs are unsuitable for syphilis PCR.
  • Offer syphilis screening to all asymptomatic patients as part of regular sexual health check-ups. This includes MBS item 715 health assessments for Aboriginal and Torres Strait Islander people.
  • A diagnosis of chlamydia or gonorrhoea indicates that the patient is at risk of syphilis.
  • Test for syphilis and HIV in persons diagnosed with or a contact of a person with an STI.
  • Offer syphilis screening to persons with evidence of injecting drug use. Injecting drug use is emerging as a behavioural risk factor for syphilis acquisition.
  • Ascertain the pregnancy status of all potentially pregnant persons tested for syphilis or other STIs.
  • Screen for syphilis at the first antenatal visit. Repeat screening is indicated if the pregnant person or their sexual partner/s are considered at high risk of acquiring STIs, or the risk is uncertain.
  • Urgently recall all pregnant persons with reactive syphilis serology to assess the need for treatment.
  • Treat patients with infectious syphilis promptly with 1.8g/2.4 million units benzathine penicillin (Bicillin L-A) via intramuscular injection (IMI).
  • Treat patients with non-infectious syphilis (i.e. asymptomatic infection with no evidence of seroconversion or fourfold rise in reactive plasma regain (RPR) titre in the previous two years) with 1.8g/2.4 million units benzathine penicillin IMI weekly for 3 weeks.
  • Treat contacts of syphilis presumptively with 1.8g/2.4 million units benzathine penicillin IMI and collect syphilis serology concurrently.
  • Consider ordering benzathine penicillin (Bicillin L-A) through the Emergency Drug Supply Schedule (Prescriber Bag), in order to minimise the risk of treatment delay (
  • Repeat RPR testing at 3, 6, and 12 months to monitor treatment response and exclude re-infection.
  • Notify the Communicable Disease Control Branch
  • Download and fax the maroon notification form to (08) 7425 6696.
  • Notify by phone on 1300 232 272 if public health advice is required.
  • Contact Adelaide Sexual Health Centre for clinical advice on (08) 7117 2800, or CDCB for public health management advice on 1300 232 272, including services through the SA Syphilis Register for Aboriginal and Torres Strait Islander patients.
  • See the Australian STI Management Guidelines available at

Locating, testing, and treating partners of infectious cases is essential in controlling syphilis.

Syphilis Information and Resources for Health Professionals

Get Lucky, Get Tested for Syphilis Campaign Resources

Access our Get Lucky, Get Tested for Syphilis Resources

The following organisations can provide advice and guidance around syphilis testing and treatment.

Adelaide Sexual Health Centre

Phone: (08) 7117 2800


Phone: (08) 8300 5300

Aboriginal Health Council of South Australia

220 Franklin Street, Adelaide SA 5000
(Postal address: GPO Box 719 Adelaide SA 5001)
Phone: (08) 8273 7200

Call our Sexual Healthline

The Sexual Healthline is open Monday - Friday, 9:00am - 12:30pm
Country callers: 1800 188 171 (toll-free)