Indications for Testing
Testing in antenatal care
A pregnant person with untreated syphilis can pass that infection to their baby, causing stillbirth, miscarriage, preterm birth, neonatal death and low birthweight. Congenital syphilis can be prevented if the pregnant person is treated >30 days before delivery.
Due to the increasing numbers of congenital syphilis cases, national guidelines advise that ALL pregnant people should be screened at least THREE times in each pregnancy:
- at the first antenatal visit
- at 26-28 weeks,
- and at 36 weeks or birth (whichever is earlier)
National Guidelines:
- Syphilis – CDNA National Guidelines for Public Health Units
- Living Evidence for Australian Pregnancy & Postnatal Care (LEAPP)
- RACGP and NACCHO National guide to preventative healthcare for Aboriginal and Torres Strait Islander People
Some pregnant people may be at greater risk of syphilis and require additional tests. Additionally, some regions recommend additional universal and risk-based testing for syphilis in pregnancy.
Click on your state or territory to view syphilis screening recommendations in pregnancy:
Please note that recommendations may change so always review your current local guidelines.
- Test all pregnant people in the ACT for syphilis at least three times during each pregnancy: at confirmation of pregnancy and/or the first antenatal appointment, at 26-28 weeks gestation, and at 34-36 weeks gestation or at birth (whichever is earlier).
- Undertake additional testing for syphilis at any gestation and post-partum if a pregnant person:
- presents with signs or symptoms of syphilis or other STIs
- presents as a contact of a person with a STI
- has received minimal or no antenatal care
- requests syphilis testing
- ACT Australian Pregnancy Care Guidelines
- ACT Public Health Recommendation for Syphilis Testing in Pregnancy
- Test all pregnant people in NSW for syphilis at least twice during each pregnancy: at first antenatal visit and again at 26–28 weeks gestation.
- Complete additional syphilis screening at 33-36 weeks and birth for pregnant people at increased risk of syphilis. Increased risk includes a previous syphilis diagnosis, any STI diagnosis in the past 12 months, illicit substance use in the past 12 months, a new male sexual partner or a male sexual partner who has sex with other men, high risk sexual activity, or sexual contact with a known infectious syphilis case.
- All pregnant people who have received minimal or no antenatal care, or are at risk of missing an appointment, should always be opportunistically screened at the service they present at, regardless of gestation.
- NSW Syphilis in Pregnancy and Newborns Policy Directive – October 2023
- Test all pregnant people in the NT for syphilis at least five times during antenatal care: at the first antenatal visit, at 28 weeks gestation, at 36 weeks gestation, at birth, and six weeks after birth.
- NT Health – Congenital Syphilis
- Test all pregnant people in QLD for syphilis at least three times during each pregnancy: at the first antenatal visit, at 26-28 weeks gestation, and at 36 weeks gestation.
- If syphilis status is unknown at birth, testing is recommended.
- Actively consider the risk of syphilis infection at each contact during pregnancy and consider opportunistically testing if there is increased risk of syphilis, this includes:
- High risk sexual activity (oral, anal or vaginal intercourse without a condom with new, multiple, or anonymous people or with a sexual partner who has other concurrent sexual contacts)
- History of STIs in the last 12 months
- Complex social circumstances
- Limited engaged in healthcare
- Adolescent pregnancy
- Drug or alcohol use impacting health
- Domestic and family violence
- Financial hardship
- Discrimination/intergenerational trauma
- Incarceration (of pregnant person or their sexual partner)
- Concern for mental health
- QLD Syphilis and Pregnancy – Dec 2024 Guidelines
- Test all pregnant people in SA for syphilis at least three times during each pregnancy: at the first antenatal visit, at 26-28 weeks gestation, and at 36 weeks gestation (or at time of preterm birth).
- Consider additional testing at birth and at 6-week postnatal check if the pregnant person is at increased risk.
- Increased risk factors:
- Identify as an Aboriginal and/or Torres Strait Islander person
- History of any STI diagnosis or is a sexual contact of a person diagnosed with an STI (in current pregnancy or in previous 12 months)
- Has had no antenatal care, or presents for their first antenatal visit at/or after 28 weeks gestation
- Has had new sexual partner/s since they became pregnant
- Has had sex with men who have sex with men
- Uses (or partner uses) illicit substances
- South Australian Perinatal Practice Guideline: Syphilis in Pregnancy and the Neonate
- Test all pregnant people in Tasmania for syphilis at least three times during each pregnancy: at confirmation of pregnancy and/or the first antenatal visit, at 26-28 weeks gestation, and at 36 weeks or at birth (whichever is earlier).
- Consider additional syphilis tests at any gestation, at birth and post-partum when there is any concern that a pregnant person may have been exposed to syphilis, they have symptoms of syphilis, or their syphilis status is unknown.
- Tasmanian Government Health Alert: Syphilis testing in pregnancy
- Test all pregnant people in Victoria for syphilis at least three times during each pregnancy: at the first antenatal visit, at 26-28 weeks gestation, and 36 weeks or birth (whichever is earlier).
- In addition, any pregnant person presenting with signs and symptoms suggestive of an STI or who has been exposed to an STI should be tested for syphilis.
- VIC Health – Congenital Syphilis in Victoria
- Test all pregnant people in WA for syphilis at least three times during each pregnancy: at the first antenatal visit, at 28 weeks gestation and 36 weeks gestation (or time of pre-term birth).
- Pregnant people living in regions affected by the ongoing outbreak in Aboriginal communities (i.e. Kimberley, Pilbara and Goldfields) to receive additional tests at delivery and at six weeks post-partum
- WA STI and BBV guidelines (Silver book) Quick guide for testing and treatment of syphilis infection in WA
Antenatal care and STI testing:
When talking to pregnant people about sexual behaviour and STI testing, emphasise the importance of detecting and treating STIs early to minimise the risk of transmission to the unborn baby. Do not assume that the pregnant person currently has a partner or is not seeing multiple partners.
Reinforce that the testing is routine and that everyone receiving antenatal care is encouraged to be tested.
Engagement in antenatal care:
Several factors influence pregnant people’s engagement in antenatal care, including cultural and socioeconomic considerations. Cultural factors may impact access and comfort with services, particularly where there is a lack of culturally safe care or representation from Aboriginal and/or Torres Strait Islander staff.
Limited English proficiency and cultural or religious beliefs and practices can also shape how antenatal care is perceived and prioritised. Fear of government agencies, stigma, and discrimination or family and domestic violence situations may further deter pregnant people from seeking care.
Given these barriers, opportunistic testing for pregnant people during any engagement with healthcare is essential, as some patients may not re-engage with services until the time of delivery.