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Guideline for the management of the pregnant women with syphilis
Syphilis and congenital syphilis are notifiable conditions1
ALL sexual health checks should include comprehensive STI testing, including blood testing for syphilis and HIV.
Universal repeat screening for syphilis at the first antenatal appointment, 26 to 28 weeks and 36 weeks is now recommended in all pregnancies.
Locating, testing, and treating partners of infectious syphilis cases is critical for controlling syphilis transmission.
After completing treatment, it is critical to repeat RPR testing of cure at 3 months, 6 months and 12 months.
Syphilis is a sexually transmissible infection (STI) caused by a bacterium called Treponema pallidum.
There is an increased prevalence of syphilis in South Australia (SA) affecting multiple population groups across metropolitan and country SA.
Syphilis is highly infectious during the first two years of infection, and can be transmitted through unprotected vaginal, anal and oral sex, and through skin-to-skin contact.
Syphilis can also be transmitted during pregnancy and childbirth (congenital syphilis).
Having syphilis increases the risk of both acquiring and transmitting HIV.
Untreated syphilis has four stages: primary, secondary, latent and tertiary.
It can take up to 90 days for symptoms of syphilis to show (if at all). Symptoms of syphilis can vary depending on the stage of infection.
For further information about the symptoms of syphilis see:
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.
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.
Please note that the South Australian Perinatal Practice Guidelines are currently under revision to reflect these changes to universal screening for syphilis in pregnancy.
All medical practitioners:
Collect serology for syphilis on the day of treatment and other STI tests as indicated.
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.
Five cases of congenital syphilis have been notified in SA since 2017, occurring in the context of an ever-increasing trend for cases of both syphilis and congenital syphilis in SA and nationally. Prior to 2017, congenital syphilis had not been reported in SA since the 1990s.
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.
Communicable Diseases Network Australia’s (CDNA) national guidelines for syphilis recommend the consistent and systematic investigation of all congenital syphilis cases.
In SA, the process of undertaking a public health review of each congenital syphilis case was established in 2020. With the overarching aim of minimising the risk of future cases of congenital syphilis, the specific purposes of a congenital syphilis case review are to:
Case Review Reports:
1 In South Australia the law requires doctors and laboratories to report some infections or diseases to SA Health. These infections or diseases are commonly referred to as 'notifiable conditions'