The number of infectious syphilis cases in Australia has been rising since 20111. Until recently, this was due primarily to an outbreak in communities in rural and remote Australia, which disproportionately impacted Aboriginal and Torres Strait Islander people2. However, the epidemiology of syphilis in Australia has evolved with a shift to include people living in major cities.
The most recent national syphilis surveillance report in 2022 shows the greatest proportion of syphilis cases occurred in non-Indigenous men, with the majority living in cities3.
It is critical for health professionals, particularly those in urban areas, to be aware of developments during the ongoing outbreak and to be alert for potential cases of infectious syphilis.
What is syphilis?
Syphilis is caused by the Treponema pallidum bacterium. It is a sexually transmitted infection (STI) that can result in serious complications if it is not treated.
Untreated syphilis progresses through primary, secondary, latent and tertiary stages over years or decades (see symptoms below).
In the long term, untreated syphilis can cause brain infections, dementia, lung and heart failure, blindness and death.
In pregnant people, untreated or inadequately treated syphilis can be passed from parent to fetus, resulting in congenital syphilis, which may cause:
- Miscarriage
- Stillbirth
- Prematurity
- Low birth weight
- Death shortly after birth
- Serious health issues for the baby such as organ, brain or nerve damage.
Testing for syphilis and other STIs should be part of pre-conception health care for men.
Syphilis and male fertility
Syphilis complications, such as epididymitis, may also have adverse impacts on male fertility because of associated scarring and obstructions4,5.
What are the symptoms of syphilis?
During the latent phase of syphilis, symptoms are absent but sexual transmission is possible for two years after infection, and congenital infection of the fetus is possible at any stage.
Neurological, cardiovascular and skin complications characterise tertiary syphilis, which can occur from months to years after infection.
Prevention measures
Patient educational resources, including posters, and facts sheets, are available here.
To help patients feel comfortable talking about their sexual health, refer to our tips for respectful and inclusive sexual history taking. When talking about syphilis with your patients, explain that it is nothing to be ashamed of, as most people have or will have an STI in their life.
You can find a comprehensive syphilis discussion guide for health professionals here.
When to test for syphilis
Refer to the Australian STI Management Guidelines for Use in Primary Care for the most up-to-date list of clinical indicators for testing.
What to do if you suspect a potential case of syphilis
Confirmed and probable syphilis cases should be notified to your state or territory’s public health unit.
You can find a helpful decision-making tool covering testing guidance, patient referral, syphilis treatment and follow-up information here.
