Syphilis is a sexually transmissible infection (STI) usually caused by having vaginal, oral or anal sex with a person who is infected. Both men and women can be infected. Syphilis can also be passed on during pregnancy from mother to child.

Current situation

The Northern Territory syphilis outbreak is ongoing, with 2,064 outbreak cases notified from 1 July 2013 to 26 October 2023. A case of congenital syphilis has been notified in Central Australia in August 2023.

About

In recent months, the majority of infectious syphilis cases have been reported in Central Australia and Barkly Regions, followed by the Katherine Region. Untreated syphilis can have devastating consequences in pregnancy, leading to miscarriage, stillbirth, neonatal death, low birth weight and congenital syphilis.

Common presentations of infectious syphilis in adults include:

  1. painless oral, anogenital ulcer/s (occasionally painful),
  2. regional lymph node enlargement,
  3. rashes that can involve palms and soles,
  4. patchy hair loss,
  5. fever,
  6. sore throat and
  7. fleshy lesions resembling genital warts, ocular involvement and transaminitis.

Most babies with congenital syphilis are asymptomatic at birth. Typical symptoms include ulceration of nasal mucosa with nasal discharge ‐ rhinitis, (‘snuffles’), skin rashes or lesions, hepatosplenomegaly, generalised lymphadenopathy, haematologic abnormalities, osteochondritis, CNS abnormalities, chorioretinitis, nephrotic syndrome and pancreatitis. Further information: https://hdl.handle.net/10137/707

Actions

  1. We urge clinicians to repeat syphilis serology in all pregnant women after the initial serology during pregnancy.
  2. The current recommendation is to test all pregnant women in outbreak areas for syphilis at the first visit (including request for test), 28 weeks, 36 weeks, delivery and six weeks postpartum.
  3. Test all other pregnant women for syphilis at the first visit, 28 weeks and 36 weeks or at the time of any preterm birth.
  4. Offer syphilis testing to partners of pregnant women.

Transmission

Syphilis spreads by direct contact with skin lesions or mucous membranes of an individual with infectious syphilis during anal, oral or vaginal intercourse. Vertical transmission can occur at any time during pregnancy and any stage of syphilis.

Clinical management

  1. If you suspect syphilis, treat immediately with Benzathine penicillin 2.4 million units IM stat (2 pre‐filled syringes) – don’t wait for serology results.
  2. Treat contacts and symptomatic people with Benzathine penicillin 2.4 million units IM stat (2 pre‐filled syringes) and perform serology for syphilis and HIV.
  3. Collect dry swabs from all genital ulcers/lesions for Syphilis PCR (NAAT).

Prevention

To reduce the risk of untreated syphilis, CDC recommends the following:

  1. Do twice yearly STI (including syphilis and HIV serology) screening for all young people at risk (especially for those aged 15‐34 years old)
  2. If a Point of Care test for syphilis is done and found positive with no previous positive serology, treat immediately and take syphilis/HIV serology.

Public health management

Actively follow up contacts/request clients to inform sexual partners and encourage them to attend for treatment.

For more information, visit the NT Health website, or contact the RAHC Clinical Team or visit any of the following health pages:

  1. https://www.healthdirect.gov.au/syphilis
  2. https://www.staystifree.org.au/get-the-facts/syphilis
  3. https://youngdeadlyfree.org.au/

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