Metropolitan Perth syphilis outbreak alert

Professor Donna Mak, Public Health Physician at Communicable Disease Control Directorate, WA Department of Health and School of Medicine, University of Notre Dame, and Sessional GP at M Clinic, WA AIDS Council.

Up until two years ago, syphilis in metropolitan Perth occurred primarily among men who have sex with men. However, the number of women acquiring syphilis is increasing and there has been a pronounced increase among vulnerable and high priority groups, including young Aboriginal and non-Aboriginal people, people who are experiencing homelessness, culturally and linguistically diverse communities and people who inject drugs.

Aboriginal people comprised 12 per cent of notifications of infectious syphilis in the metro area in 2020, compared to less than one per cent in 2015. There have been 26 infectious syphilis notifications in people experiencing homelessness in the past 18 months, compared to six in the previous four years combined. Of individuals experiencing homelessness notified with infectious syphilis since 2017, half are Aboriginal people.

Notifications in women of childbearing age increased nearly six-fold between 2015 and 2019, and there have been eight notifications in pregnant women in the first half of 2020. There have been two cases of congenital syphilis in Perth since 2018, including one stillbirth, both in women from vulnerable groups who contracted syphilis during pregnancy which was not diagnosed until the time of delivery.

What does this mean for GPs and primary health care providers?

  • Be aware that infectious syphilis is increasing significantly in metropolitan Perth. Vulnerable populations include Aboriginal and non-Aboriginal people, culturally and linguistically diverse people, homeless people and people who inject drugs. Of particular concern are the women of reproductive age in these groups.
  • Take blood for syphilis testing from all patients attending for diagnosis and treatment of any STI, or where screening for STIs is indicated.
  • Offer opportunistic screening for STIs, including syphilis, to identified vulnerable populations.
  • Take blood for syphilis testing at the booking appointment, 28 weeks, 36 weeks and delivery from all pregnant women from vulnerable and higher risk groups.
  • Do a pregnancy test on all women of childbearing age diagnosed with syphilis.
  • Provide presumptive treatment with benzathine benzylpenicillin injection 2.4 million units (1.8 gm) IM stat to all patients with clinical signs of infectious syphilis and all sexual contacts of infectious syphilis. Syphilis of longer or unknown duration should be treated once weekly for three weeks.
  • Benzathine benzylpenicillin is available as a Doctor’s Bag item
  • Syphilis serology (including RPR) should be repeated at the time of treatment and then be checked at three, six and 12 months post-treatment.
  • All cases should be notified promptly to the Department of Health. MCDC can assist with contact tracing, provision of benzathine benzyl penicillin and advice on management.
  • Discussion with a sexual health specialist is recommended for pregnant patients, HIV co-infection, and tertiary syphilis.
  • Complete the Australasian Society Sexual Health, Viral Hepatitis and HIV Medicine’s Syphilis Outbreak on-line training approved by RACGP for 4 CPD points, and endorsed by the Australian College of Nursing (ACN) and the Nursing and Midwifery Board of Australia.
  • Contact Metropolitan Communicable Disease Control on 9222 8588, Mon-Fri 8am-5pm if you wish to discuss management of a syphilis case or require assistance to obtain benzathine penicillin or with contact tracing.

For further information, refer to: