Infectious syphilis outbreak in SA

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 extended to metropolitan Adelaide in November 2018. As of August 2020, case numbers continue to increase across all regions. 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, three children have been born with congenital syphilis. Syphilis also increases the risk of HIV transmission.

Medical practitioners in the outbreak areas and surrounding regions

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

All 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.

South Australian syphilis outbreak response

In response to the syphilis outbreak, in 2017 the Communicable Disease Control Branch formed the SA Syphilis Outbreak Working Group (the Working Group) comprised of representatives from various government, non-government and community-controlled health services. The Working Group’s role is to monitor and coordinate the state syphilis outbreak response, with the aim of concentrating immediate efforts to contain the current outbreak, while simultaneously seeking to develop sustainable, long term interventions designed to improve the sexual health of populations in outbreak affected areas and more broadly. In order to achieve this aim, the Working Group developed the South Australian Syphilis Outbreak Response Plan, 2019 (PDF 318KB) that has been endorsed by the Minister for Health and Wellbeing as a priority.

Congenital syphilis

Since the commencement of the outbreak in South Australia, there have been two cases of congenital syphilis born to women who identify as Aboriginal, one in May 2020 and one in September 2020. The previous case of congenital syphilis was in 2017.

A Congenital Syphilis Review Group (the Review Group), comprised of a wide range of representative members, across government and non-government agencies, was established to investigate the issues surrounding the two more recent cases.

The Congenital Syphilis Case Review Report identifies a range of local system-level issues requiring attention, along with recommendations for review of clinical protocols, and prevention, education, community engagement and workforce development processes.

The Review Group also identified significant long term, system-wide, embedded issues that contribute to a lack of safety for Aboriginal mothers and pregnant women in accessing health and other government services and therefore have a significant negative impact on outcomes for mothers and their babies. These include ongoing experiences of institutionalised racism that are at the core of health and education inequities. Thus, the Review Group recommendations place significant focus on these issues.

The SA Syphilis Register

The SA Syphilis Register is a secure, confidential, single statewide database that includes all laboratory positive syphilis cases diagnosed in Aboriginal and Torres Strait Islander South Australians that meet the syphilis national case definition. Register staff may undertake or assist with Partner Notification, (also known as contact tracing) for all contacts of Aboriginal and Torres Strait Islander cases, regardless of Aboriginality. Register staff contact partners (or coordinate the contacting of partners) with the aim of coordinating syphilis screening and treatment, where appropriate.

More information