Syphilis

Outbreak Training Website

This page contains information specific to syphilis in metropolitan Perth. Please review it in addition to all other chapters for the complete picture of syphilis notifications and management.  

Western Australia, syphilis notifications:

Introduction

Until 2017, syphilis in the Perth metropolitan area occurred primarily among men who have sex with men (MSM). However, the number of women acquiring syphilis is increasing and there has been an increase in notifications among high priority groups, including:

  • young Aboriginal and non-Aboriginal peoples,
  • people who are experiencing homelessness,
  • culturally and linguistically diverse communities and
  • people who inject drugs.

This page contains information specific to syphilis in metropolitan Perth. Please review it in addition to all other tabs for the complete picture of syphilis notifications and management.  

Epidemiology

Notifications in women of childbearing age increased nearly 18-fold between 2015 and 2021 in Perth metro area and comprises 26% of all syphilis notifications. There have also been many cases in pregnant women (4.6%). Tragically, there have been six cases of congenital syphilis in Perth since 2018, including stillbirth, in women from priority populations who contracted syphilis during pregnancy which was not diagnosed until the time of delivery.

Syphilis Notifications

Aboriginal and Torres Strait Islander people comprised 13% of notifications of infectious syphilis in the metro Perth area in 2021, compared to less than one per cent in 2015. Within Perth metro, 5 per cent of infectious syphilis cases are attributed to people experiencing homelessness.

Figure 13 Number of infectios syphilis notifications among pregnany women....

Testing and management

What should GPs and primary care providers in Perth do to respond?

Increase Testing: Offer syphilis testing to patients presenting for the following reasons:

  • Offer and encourage all sexually active people under 35 years of age to have regular STI screens, including syphilis testing.
  • Offer syphilis testing (as part of a comprehensive STI test) during reproductive health visits and whenever someone requests an STI test.
  • Undertake routine syphilis testing of all pregnant people at booking appointment, at 28 weeks and 36 weeks. For high-risk women, undertake additional testing at delivery and 6 weeks post-partum. Additional opportunistic testing should be undertaken when indicated, for example, if any risk behaviours or suggestive symptoms and signs are found (Silver Book under ‘pregnant and post-partum women).

 

Syphilis case management dependant on presentation

ALL Cases

Syphilis serology including Rapid Antigen Reagin (RPR) should be repeated at:

  • time of treatment
  •  then three months post-treatment,
  •  six months post-treatment and
  • 12 months post-treatment.

All cases should be notified promptly to the Department of Health (see Notification Requirements below).

Metropolitan Communicable Disease Control (MCDC) can assist with contact tracing, provision of benzathine benzylpenicillin and advice on management.

Pregnant Women

Do a pregnancy test on all women of childbearing age diagnosed with syphilis (see also exceptional cases).

Presumptive positive cases

Administer 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.

Note: Benzathine benzylpenicillin is available as a Doctor’s Bag item.

> 2 year OR unknown duration of syphilis infection

Treat with benzathine benzylpenicillin injection 2.4 million units (1.8 gm) IM stat

Once weekly for three weeks.

Note: Benzathine benzylpenicillin is available as a Doctor’s Bag item.

Exceptional cases

Discussion with a sexual health specialist is recommended for pregnant patients, HIV co-infection, and tertiary syphilis.
Treatment

Watch this video on administering benzathine penicillin treatment for syphilis [9 minutes]:

Structured Administration and Supply Arrangements (SASAs)

The Structured Administration and Supply Arrangements (SASAs) for Treatment of Syphilis Infection by Registered Nurses and Aboriginal Health Practitioners enable the administration of antibiotics for treatment of syphilis in WA.

Please click on the links below to read the relevant SASA

More information

For the most current testing and management recommendations for WA, always refer directly to Syphilis testing and management in the Siliver Book.  The testing and management tab provides further general information about syphilis testing and management.

Support

If you wish to discuss management of a syphilis case, require assistance to obtain benzathine penicillin or need support with contact tracing, contact Metropolitan Communicable Disease Control on 9222 8588, Mon-Fri 8am-5pm.

Notification requirements

In WA, syphilis is notifiable under the Public Health Act 2016 and the Public Health Regulations 2017. A notification form needs to be completed by a medical officer or nurse practitioner and faxed to the nearest regional or metropolitan Public Health Unit (PHU) as soon as possible and within 72 hours of the diagnosis. The receipt of a notification form will trigger the PHU to contact the service provider to complete the enhanced surveillance form and discuss both treatment and contact tracing.

Notification forms: https://ww2.health.wa.gov.au/Silver-book/STI-or-HIV-notification

Guidelines

For the most up-to-date recommendations in Western Australia, always refer directly to the Silver Book.