Syphilis

Outbreak Training Website

Introduction


Until 2017, syphilis in metropolitan Perth occurred primarily among men who have sex with men. However, the number of women acquiring syphilis is increasing and there has been a pronounced increase among vulnerable and high priority groups, including

  • young Aboriginal and non-Aboriginal people
  • 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 six-fold between 2015 and 2019 in the metro Perth area, and there have been eight notifications in pregnant women in the first half of 2020.

There have been two cases of congenital syphilis in Perth since 2018, including one stillbirth, both in women from vulnerable groups who contracted syphilis during pregnancy which was not diagnosed until the time of delivery.

Aboriginal people comprised 12 per cent of notifications of infectious syphilis in the metro Perth area in 2020, compared to less than one per cent in 2015.

There have been 26 infectious syphilis notifications in people experiencing homelessness in the past 18 months, compared to six in the previous four years combined. Of individuals experiencing homelessness notified with infectious syphilis since 2017, half are Aboriginal people.

Key changes in syphilis epidemiology in vulnerable populations, Perth metropolitan area, 2015 to 15 June 2020

View real-time syphilis notification data at the WA Department of Health website

Download the latest quarterly and annual ‘Epidemiology of STIs and BBVs in Western Australia’ reports here


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:

  • Diagnosis and treatment of any STI, or where screening for STIs is indicated
  • When offering opportunistic STI screening to people in identified vulnerable populations.
  • All pregnant people at booking appointment, with additional tests at 28 weeks and delivery for people at medium risk, and at 28 weeks, 36 weeks, delivery and 6 weeks post-partum for people at high risk. (For information on who is at medium and high risk, refer to the Silver Book under ‘pregnant and post-partum women’)

Management

  • Do a pregnancy test on all women of childbearing age diagnosed with syphilis.
  • Provide presumptive 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. Syphilis of longer or unknown duration should be treated once weekly for three weeks.
  • Benzathine benzylpenicillin is available as a Doctor’s Bag item
  • Syphilis serology (including RPR) should be repeated at the time of treatment and then be checked at three, six and 12 months post-treatment.
  • All cases should be notified promptly to the Department of Health (see Notification Requirements below). MCDC can assist with contact tracing, provision of benzathine benzyl penicillin and advice on management.
  • Discussion with a sexual health specialist is recommended for pregnant patients, HIV co-infection, and tertiary syphilis.

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

SASA - Treatment of Syphilis Infection by Aboriginal Health Practitioners

SASA - Treatment of Syphilis Infection by Registered Nurses

More information

For the most current testing and management recommendations for WA, always refer directly to the Silver Book.

Review the testing and management tab for 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.