GP Connect Clinical Feature by Dr Sarah Smith KEMH Liaison GP and Donna Mak, Public Health Physician
Infectious syphilis cases are increasing across the country and Australia’s Chief Medical Officer recently declared syphilis to be a communicable disease incident of national significance.
Infectious syphilis case numbers in Western Australia (WA) have surged by almost 300 per cent over the past 10 years, from 162 in 2015 to 774 in 2025. All of WA is now a declared outbreak area. Sadly, this is also reflected in increasing cases of congenital syphilis, a preventable cause of stillbirth and neonatal and lifelong complications. Of concern, there were three cases of congenital syphilis notified in WA in 2025, which reflects ongoing high levels of infectious syphilis in the community.
Syphilis can present in many ways and often has no or minimal symptoms. Recent syphilis cases in WA have been identified by a wide range of specialists including GPs, dermatologists, dentists, ophthalmologists, rheumatologists, emergency physicians and obstetricians – it is the great masquerader.
Given the rise in cases across all population groups, if we are not testing for syphilis then cases will be missed. Most people with syphilis do not know they are at risk, and most will not have symptoms.
The new ASHM Stop Syphilis campaign has launched to increase Syphilis awareness amongst GPs and healthcare workers, with the key message being Syphilis is back, put it on your radar. The campaign includes an excellent syphilis conversation guide to assist with bringing syphilis into every day consultations and encouraging testing, and to help educate your patients about this infectious disease.
Congenital syphilis – what you need to know
Early identification of syphilis in pregnancy enables treatment that can positively change the life course of both the pregnant mother and baby. Treatment in pregnancy is both safe and effective.
WA and national pregnancy care guidelines recommend that everyone has routine syphilis testing at three key points during every pregnancy:
- At diagnosis of pregnancy.
- At 24 weeks (at time of routine 24 to 28 week blood tests).
- At 36 weeks (at time of routine 36 week blood tests).
The following additional testing in pregnancy is also recommended:
- Routinely at time of any premature birth.
- Opportunistically when an STI or risk for an STI is identified.
- Whenever a patient requests testing.
- Opportunistically when routine antenatal care schedule is disrupted – consider socioeconomic issues, and risk factors such as housing instability, substance use, mental health issues which can all affect access to care.
What can I do as a GP to reduce cases?
Implement the five Ts to tackle syphilis in your daily practice:
- Talk about syphilis with your patients.
- Think of syphilis when considering diagnosis.
- Test for syphilis – PCR swab of mucosal lesions and syphilis serology.
- Treat syphilis promptly.
- Trace contacts with support from local Public Health Units.
Consider the following practice audit and quality improvement activities:
- Is syphilis serology included in antenatal blood request forms at the first visit, 28 and 36 weeks?
- Check and add it to the request forms in your practice software.
- Is syphilis serology included in routine STI test requests?
- Think STI = Think Syphilis.
- Is syphilis PCR requested when investigating mucosal ulcers/lesions?
- Check and add it to the request forms in practice software.
- Is pregnancy considered whenever a female of reproductive age undergoes syphilis testing?
- Check and add pregnancy test (urine or beta-HCG) consideration to syphilis test requests.
- Audit if a positive test result is obtained, is pregnancy status determined within one working day?
Staff and patient education
Consider doing a practice education session on syphilis with your colleagues, using the ASHM Stop Syphilis campaign resources and local data.
The WA Notifiable infectious disease dashboard contains real-time information about syphilis notifications broken down by sex, age-group, region and Aboriginal status. It is a great resource to help discussions with patients and colleagues about syphilis.
Display posters and patient education materials in your waiting room, you can find out how to order resources from the “ordering resources” page on the WA STI and BBV guidelines page.
Together we can all make a difference with small changes that will help prevent congenital syphilis and the stop the spread of syphilis in WA.
Think of syphilis and make a difference today. Keep syphilis on your radar.
More information and resources for GPs are available below: