Syphilis for health professionals


Syphilis outbreak extends to Adelaide

An outbreak of infectious syphilis affecting rural and remote Aboriginal communities in the Far North and Eyre and Western regions of South Australia (SA) since November 2016 has now extended to metropolitan Adelaide. A total of 49 cases have been notified in the Far North and Eyre and Western region since the outbreak was declared. In metropolitan Adelaide, a further 15 cases have occurred, with a small but sustained increase in the past six months. This outbreak is part of a multi-jurisdictional outbreak of syphilis occurring across northern Australia in predominantly rural and remote Aboriginal and Torres Strait Islander communities.

Syphilis is highly infectious during the first two years of infection. Pregnant women can transmit syphilis to their babies, which can result in perinatal death, premature delivery, and congenital abnormalities. In SA, five cases of infectious syphilis have occurred in pregnant women, and one child has been born with congenital syphilis. Syphilis also increases the risk of HIV transmission.

Medical practitioners in the outbreak areas and surrounding regions are advised to:

  • Offer syphilis testing to Aboriginal and Torres Strait Islander people and their partners in the following circumstances:
    • Where there is a clinical suspicion of syphilis.
    • During routine sexually transmitted infection (STI) screening in 16-40 year olds (offer HIV testing as well).
    • In anyone who is diagnosed with another STI such as chlamydia, gonorrhoea or trichomonas (offer HIV testing as well).
    • In anyone aged 16-40 years who is having a blood test for another reason – e.g. during an adult health check, or emergency department presentation.
    • During antenatal testing – in addition to testing at the first visit (10-12 weeks), repeat testing at 28 weeks, 36 weeks, at delivery, and at the 6 week post-natal check.
  • Offer screening for syphilis in all sexually active patients, if considered at risk.
  • Contact SA Pathology on (08) 8222 3000, or Adelaide Sexual Health Centre on (08) 7117 2800 if assistance with interpretation of syphilis serology results is required.

Medical practitioners should:

  • Treat infectious syphilis (duration <2 years) with:
    • Intramuscular (IM) benzathine penicillin 1.8g (2.4 million units).
    • Women diagnosed in the third trimester should be treated with a second dose of IM benzathine penicillin 1.8g (2.4 million units) 7 days later.
  • Treat patients likely to have had untreated syphilis for longer than 2 years, or of unknown duration, with three doses of IM benzathine penicillin 1.8g (2.4 million) given 7 days apart.
  • If there is a history of penicillin allergy, consult with an Infectious Diseases or Sexual Health Physician.
  • Test and treat for syphilis on the same day of presentation for all people with genital ulcers – do not wait for a positive result.
  • Notify cases of syphilis to the Communicable Disease Control Branch on 1300 232 272.

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