If a pregnant person has an untreated syphilis infection or reinfection during pregnancy or childbirth, it can lead to foetal death, premature delivery, or severe, permanent disability in the child.

Each occurrence of a congenital syphilis case is a sentinel event reflecting potential missed opportunities for prevention in the public health, antenatal and primary health care systems. SA Health conducts a public health review of each congenital syphilis case. For more information: Congenital Syphilis Case Reviews.

Is a life-threatening condition affecting a person’s central nervous system. Neurosyphilis can occur at any time after initial syphilis infection and can cause a range of severe outcomes including loss of vision or hearing, palsies and dementia.

Is a common issue in some groups. Reinfections are more likely to be asymptomatic and therefore harder to detect. Repeat testing for cure after treatment is critical.

Test all pregnant people at:

• the first antenatal appointment (ideally <10 weeks)
• 26-28 weeks
• 36 weeks.

Health services should offer opportunistic screening for syphilis to any pregnant person who has presented late for antenatal care or has had interrupted antenatal care when they present for health care.

In addition to the above, testing at birth and at the six week postnatal check is recommended for pregnant people at increased risk for syphilis in pregnancy. Refer to the SA Perinatal Practice Guideline for Syphilis in Pregnancy and the Neonate for further information about populations at increased risk.

The South Australian Perinatal Practice Guidelines and the South Australian Pregnancy Record were updated in January 2025 to reflect these changes to universal screening for syphilis in pregnancy.

People with any signs and symptoms of:

• infectious syphilis
• neurosyphilis
• any other STI.

It is important for all sexually active people to get a sexual health check at least once a year, or whenever there is a new partner, as syphilis is symptomatic in around 50% of all cases.

Among some populations there are special requirements for testing due to increased burden of infection, adverse health outcomes, community prevalence or other factors. Refer to the Australian STI Management Guidelines for Use in Primary Care for testing advice for:

• Aboriginal and Torres Strait Islander people
• Men who have sex with men
• People in custodial settings
• People who use drugs
• Sex workers
• Young people (aged 15-29 years)
• Sexual partners and contacts of a person diagnosed with syphilis or any other STI.

Treat infectious syphilis (duration <2 years) with intramuscular benzathine benzylpenicillin 2.4 million units, administered as two injections, one in each buttock, stat.

Treat patients likely to have had untreated syphilis for longer than 2 years, or of unknown duration, with I intramuscular benzathine benzylpenicillin 2.4 million units administered as two injections, one in each buttock, weekly for 3 weeks.

Presumptively treat all sexual contacts from the last 3 months of patients with primary or secondary syphilis, regardless of serology, with intramuscular benzathine benzylpenicillin 2.4 million units administered as two injections, one in each buttock, stat.

For treatment of pregnant people with syphilis refer to the SA Perinatal Practice Guideline for Syphilis in Pregnancy and the Neonate.

Ongoing sexual contacts of pregnant people are the highest priority and must be presumptively treated as soon as possible to prevent re-infection during pregnancy.

Initiate and document a discussion about partner notification (contact tracing). Partner notification is essential to prevent re-infection and reduce transmission. The diagnosing doctor is responsible for this.

Refer to the Australasian Contact Tracing Guidelines: Syphilis for further information.

If there is a history of allergy to penicillin, soy or peanut, consult with an Infectious Diseases or Sexual Health Physician.

After completing treatment, it is critical to repeat RPR testing of cure at 3 months, 6 months and 12 months.

Syphilis and congenital syphilis are notifiable conditions¹. Notify cases of syphilis to the Communicable Disease Control Branch by:

• Downloading and faxing the maroon notification form to fax: (08) 7425 6696, or
• Notifying by phone on 1300 232 272 if public health advice is required.
  

• ASHM —  Australian STI Management Guidelines for Use in Primary Care]
• ASHM — Decision Making in Syphilis
• ASHM — Doxy-PEP Decision Making Tool
• Australian Government – Information for health professionals
• Australian Centre for Disease Control — Syphilis for health professionals
• SHINE SA — Syphilis Is Still Out There: Information for Health Professionals
• Aboriginal Health Council of South Australia – Sexual and Reproductive Health and BBV Program
• SA Health — SA Perinatal Practice Guideline for Syphilis in Pregnancy and the Neonate (updated January 2025)
• HealthPathways South Australia — Syphilis (you need to be a registered user)
• SA Health — SA Syphilis Register
• SA Health — Public Health Alerts (all public health alerts for SA)

• SA Health — Syphilis - including symptoms, treatment and prevention
• SA Health — Doxy-PEP (doxycycline post-exposure prophylaxis)
• SHINE SA — Syphilis
• SHINE SA — Doxy-PEP FAQs
• Australian Government – Information for Aboriginal and Torres Strait Islander peoples
• Australian Centre for Disease Control — Syphilis information for everyone

• Young Deadly Free – Resources
• Australian Government – National response to syphilis
• Australian Government – Don’t fool around with syphilis campaign
• Australian Government – Make STI testing your Before play resources