Congenital syphilis - a sentinel public health event


1 June 2020

There is currently a multi-jurisdictional outbreak of infectious syphilis affecting rural and remote Aboriginal communities. This outbreak extended into the Far North and Western regions of South Australia (SA) in November 2016 and then to metropolitan Adelaide in 2018. A total of 111 outbreak cases have been notified in SA.

In April 2020 an Aboriginal woman presenting for her first antenatal visit at 22 weeks was diagnosed with infectious syphilis and despite treatment delivered a child with congenital syphilis one week later. Congenital syphilis is a sentinel public health event, indicating that quality of preventive and/or therapeutic medical care may require improvement.

Syphilis in pregnancy can result in perinatal death, premature delivery, and congenital abnormalities. In SA, since November 2016, seven cases of infectious syphilis have been detected in pregnant Aboriginal women, and two children have been born with congenital syphilis.

Medical practitioners in the South Australia are advised to:

  • Ensure systems are in place to support the identification of Aboriginal and Torres Strait Islander patients in any part of South Australia (metropolitan, regional and remote).
  • Consider additional ways your clinic can provide culturally safe care and be aware of alternate local antenatal care providers where relevant.
  • Offer syphilis testing to Aboriginal and Torres Strait Islander people and their partners anywhere in South Australia:
  • If there is clinical suspicion of syphilis
  • As part of 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
  • As screening in:
    • All sexually active patients
    • All women of reproductive age  
    • Gay, bisexual men and men who have sex with men
    • Highly mobile individuals
    • Anyone who is diagnosed with another sexually transmissible infection such as chlamydia, gonorrhoea or trichomonas (offer HIV testing as well)
    • Anyone aged 15-50 years who is having a blood test for another reason – e.g. during an adult health check, or emergency department presentation.
  • Ensure the patient’s contact details are current and correct for follow up of results, treatment and liaising with local Aboriginal Health services where possible.

After a diagnosis of syphilis in Aboriginal and Torres Strait Islander people

  • Seek assistance, if required, with interpretation of syphilis serology results. Contact the pathology laboratory undertaking the test, or the Adelaide Sexual Health Centre on 7117 2800, or the CDCB syphilis register on 1300 232 272.
  • Undertake treatment appropriate to the stage of syphilis. See guidelines available at https://bit.ly/3eaRvfS
  • 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 CDCB on 1300 232 272.
  • Facilitate treatment of sexual partners of patients with infectious syphilis. Controlling the outbreak requires sexual contacts of infectious cases to be located as soon as possible and then tested and treated on the same day, without waiting for positive results. CDCB syphilis register staff can assist with partner notification.

Dr Louise Flood – Director, Communicable Disease Control Branch