Be alert for Syphilis

Syphilis  

• Syphilis is a highly infectious sexually transmissible infection (STI) caused by the Treponema pallidum bacteria.
• Syphilis disproportionally impacts First Nations peoples, women of reproductive age, and gay, bisexual, and other men who have sex with men.
• Syphilis has been declared a Communicable Disease Incident of National Significance (CDINS)

Trends 

• In 2024, infectious syphilis notifications in Queensland increased by 30% when compared with the previous five-year average. Increases in notifications among women of reproductive age (15–44 years) and syphilis in pregnancy were observed in the same period.
• Infectious syphilis notifications so far this year have remained high.
  • Approximately half of these have been among gay, bisexual, and other men who have sex with men. 

  • There have been 49 notifications of syphilis in pregnancy and three notified cases of congenital syphilis.

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Testing  

• Approximately 50% of people with infectious syphilis will be asymptomatic
• Include syphilis testing as part of standard asymptomatic STI check-up
• Consider testing to exclude secondary syphilis in the presence of rashes on the trunk, palms and soles.
• Specimens: blood for serology (syphilis antibody) and PCR swab of ulcer(s) for NAAT or PCR
• Test ALL pregnant patients three times during pregnancy (Queensland Syphilis and Pregnancy Guideline):
  • Before 10 weeks
  • 26-28 weeks gestation
  • 36 weeks gestation.

Management 

• Refer to Australian STI Management Guidelines for use in Primary Care
• The correct first line treatment of infectious syphilis is Benzathine benzylpenicillin (trade name Bicillin L-A).
• Advise no sexual contact for 7 days after treatment is commenced, or until the course is completed and symptoms resolved, whichever is later.
• Clinicians performing syphilis testing are responsible for discussing partner notification, contact tracing and re-infection risk when providing results.

• Review  Australasian Contact Tracing Guideline Steps in Contact Tracing

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Queensland Syphilis Surveillance Service (QSSS)

Contact QSSS for past serology, treatment histories and advice on management and referral.

Phone: 1800 032 238 (statewide) 

• South Queensland - QLD-Syphilis-Surveillance-Service@health.qld.gov.au

• North Queensland - North-Qld-Syphilis-Surveillance-Centre@health.qld.gov.au 

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Further information

• Syphilis | Communicable disease control guidance (health.qld.gov.au)
• Presentation, testing and management – Australian STI Management Guidelines
• Webinar:  A united front: Working together to prevent congenital syphilis
• Sexual health training for health providers | Queensland Health