GPs are urged to have a high index of clinical suspicion for syphilis as cases of this ancient infection increase across WA. Currently there are three outbreaks of syphilis in WA affecting the following distinct geographical areas and populations:
1. Aboriginal people in the remote Kimberley, Pilbara and Goldfields regions – affected by a national syphilis outbreak that started in Queensland in 2011 and spread to WA in 2014.
2. Syphilis cases among men who have sex with men (MSM) in metropolitan Perth – at a new high of around 250 cases per year.
3. Heterosexual people in metropolitan Perth – cases in this group started increasing in 2016 from a low base of about 20 per year, and are continuing to increase. Of particular concern is most cases in this group are in people of child bearing age, with 76 percent of female cases being under 45 years. These patients tend to be Australia born, have acquired their infection in Australia, and were diagnosed through routine screening by their GP (so they do not fit into any traditional high-risk groups). In the past six months, two cases of congenital syphilis occurred in WA, one in Perth and one in a remote region. These are the first cases since 2013.
Communicable Disease Controls Directorate asks GPs and practice nurses to:
- Maintain a high index of suspicion for syphilis
- Normalise the offering of opportunistic STI testing
- Ensure antenatal syphilis testing at booking for all women and at 28 and 36 weeks, then also at delivery and six weeks post-partum for women from the Kimberley, Pilbara and Goldfields regions, and all other high-risk women (see also the Silver Book, or Syphilis HealthPathway)
- Contact the local public health unit help with contact tracing or have any difficulties accessing BENZATHINE penicillin for treating patients with syphilis. Note that Benzathine penicillin is now available in the Emergency Drug Supply Schedule Prescriber Bag for free supply to patients for emergency use.