Western Australia is experiencing increasing syphilis notifications. From 2012 to 2021, the annual number of infectious syphilis notifications increased elevenfold.
Advice for GPs from the Department of Health WA Communicable Disease Control Directorate
If a person has an ulcer(s) in the anogenital region or oral cavity, consider syphilis. Swab the lesion (dry swab) and order a syphilis PCR test, in addition to regular testing e.g. for herpes simplex virus (HSV) and varicella-zoster virus (VZV). Syphilis serology should be ordered.
The first line treatment is long-acting penicillin (benzathine penicillin, bicillin L-A). This can be ordered through the Doctor’s Bag so that it is available at your practice. See www.pbs.gov.au/browse/doctorsbag.
All pregnant women in WA should be offered syphilis testing (serology) at the first antenatal visit, 28 weeks and 36 weeks gestation so syphilis can be detected and treated early to prevent congenital syphilis stillbirths and life-long disability. Additional testing is advised if clinically indicated and in regional outbreak areas. WA Health urges doctors to consider that infectious syphilis is possible in their sexually active patients and offer opportunistic testing.
Who is at increased risk of infectious syphilis?
Historically, most syphilis cases occurred in Aboriginal people from regional and remote communities and gay, bisexual and, other men who have sex men in the Perth metropolitan area. While these groups continue to be at increased risk, syphilis notifications are occurring across all populations in WA. Other populations that testing should be prioritised for include:
- People experiencing homelessness
- People who use methamphetamine and/or inject drugs
- Culturally and linguistically diverse (CaLD) people
- People aged 16 – 35 years
- Women of childbearing age (currently 24% of all infectious syphilis notifications in metropolitan Perth and 48% of notifications in regional WA).
Of concern are the increasing infectious syphilis notifications among pregnant women. From 2014 to 2021, notifications increased from one to 29 cases, with 10 congenital syphilis cases (five regional and five metropolitan). Three of the congenital syphilis cases resulted in stillbirth.
Resources such as a video on benzathine penicillin injection technique and a quick guide to syphilis testing and treatment are available from the WA Syphilis outbreak response
For WA guidelines about STI testing, management and contact tracing, please see WA Guidelines for Managing Sexually Transmitted Infections (Silver Book).