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In Australia, syphilis is considered a notifiable condition and therefor any diagnosis is required by law to be reported to the appropriate jurisdictional authority. The notification process is different accross Australia. Please see the drop down menus below for each jurisdiction’s notification requirements.
The existence of a Syphilis Register in a State or Territory provides a central reference point to enquire about past treatment to enable correct treatment, and to prevent the patient being unnecessarily re-treated. QLD and NT, already have established registers, while WA and SA are looking to set one up.
Syphilis registers can record:
- Laboratory results of syphilis serology
- Treatment provided
- Dates of treatment
- Location of treatments, ie town or community and the health service
- Named contacts, their results and date tested results (if known)
- Response to treatment
Jurisdictional notification requirements
In the NT, syphilis is notifiable under the Notifiable Diseases Act 1981 [As in force at 1 May 2016]. Doctors and laboratories are required to report test results that indicate a likely new infectious syphilis case.
Notifications are stored on the NT Notifiable Diseases System (NTNDS), access to which is restricted to NT Centre for Disease Control (CDC) surveillance staff. The NT Syphilis Register Information System (SRIS) was established in early 2009 as the NT wide database for the operation of the Syphilis Register. Syphilis notifications from both laboratories and clinicians are directed to the Syphilis Register in Top End and Central in the first instance. Currently two specialist nurse Syphilis Register Operators (SROs) update this database and provide syphilis treatment and testing histories, clinical and public health management guidance to clinicians NT wide in consultation with the sexual health physician. The system has the ability to generate standard reports directly from the web interface, and advanced reports through Business Objects.
Upon receipt of new positive syphilis serology, SROs initiate follow up. SROs gather clinical information and relevant past history, advise if necessary regarding clinical examination, any further testing, treatment and contact tracing, often notifying relevant health services of a named contact in their usual care, without disclosing the identity of the index case, for provider initiated contact tracing. SROs also confirm treatment and notification of a case. Where antenatal syphilis is diagnosed, liaison with obstetric and paediatric infectious diseases clinicians is conducted to alert them to risk of congenital syphilis.
In addition to initial notification, laboratories assist with diagnosis through parallel testing when discrepancies between history, clinical information and laboratory test results occur.
- Northern Territory: https://digitallibrary.health.nt.gov.au/prodjspui/handle/10137/1014
NT Syphilis Register:
- Darwin (08) 8922 7818
- Alice Springs (08) 8951 7552
In QLD, syphilis is a notifiable condition under the Public Health Act 2005 and listed under schedule one of the Public Health Regulation 2018. Under the Public Health Act 2005 information about notifiable conditions must be reported to Queensland Health and is held in a database known as the Notifiable Conditions System (NOCS), access to which is restricted depending on a person's role within Queensland Health.
The Queensland Syphilis Register (QSR) was established in 2001 in Brisbane and 2003 in Cairns. The syphilis register is now known as the Queensland Syphilis Surveillance Service (QSSS). QSSS staff record information in the NOCS database. All tests related to the diagnosis and monitoring of syphilis and any associated treatment in individuals notified with syphilis are recorded. QSSS staff provide the treating clinician with information about a client’s history of syphilis infection to assist in diagnosis, management and treatment.
Laboratories (Queensland Health Pathology Service and private laboratories) in Queensland are required to report all positive syphilis results to NOCS. The public health nurses in Brisbane and Cairns check notifications daily for the southern and northern halves of the state respectively and contact the requesting clinician or clinic to discuss management, contact tracing and follow up of the positive notification. The QSSS will refer clinicians to sexual health clinics or infectious disease physicians if further support/advice is indicated during these discussions. Syphilis case report forms are either emailed or faxed to the treating clinician to complete. Further enhanced surveillance information is gathered from the treating clinician.
The QSSS has phone contact details at the bottom of all syphilis pathology results for both public and private laboratories. The 1800 number is directed to either Brisbane or Cairns depending on where the clinician is ringing from. Both Brisbane and Cairns have a generic email address:
QSSS phone number: 1800 032 238
In SA, syphilis is a notifiable condition under the Public Health Act 2011. It is a dual notification process where medical practitioners and laboratories are required to notify all cases of syphilis.
SA has a specific STI or Related Death notification form for a number of STIs including syphilis. It asks for clinical information (e.g. symptoms, site of infection, staging, reason for testing etc) as well as patient demographics and guidance on interpretation of syphilis test results, staging and treatment. This information is entered into SA’s notifiable disease database (Notifiable Infectious Diseases Surveillance [NIDS] database). NIDS is a secure database accessible only to staff at the Communicable Disease Control Branch (CDCB). If information is incomplete or needs to be clarified, then staff at CDCB may contact the notifying clinician.
Contact tracing and partner notification for all infectious syphilis cases (<2 years) is performed by Adelaide Sexual Health Centre (ASHC) Partner Notifications Officers on behalf of CDCB, or where indicated, by the notifying clinician/clinic with support from ASHC or CDCB. The CDCB also uses notification data to guide a number public health actions, e.g. state response to current outbreaks, longer-term workforce capacity etc.
The CDCB is currently establishing a Syphilis Register for all SA Aboriginal and Torres Strait Islander cases only, in response to the multi-jurisdictional outbreak affecting rural and remote Aboriginal and Torres Strait Islander communities in northern and central Australia. This will record previous serology results and treatment history, as well as provide advice on test interpretation and treatment, and assist with partner notification/contact tracing.
- South Australia: https://www.sahealth.sa.gov.au/NotifiableDiseaseReporting
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 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.
Laboratories are also required to report test results that indicate a likely new infectious syphilis case. Notifications are stored on the WA Notifiable Infectious Diseases Database (WANIDD), access to which is restricted to disease control medical officers and urses at the Communicable Disease Control Directorate (CDCD) and regional PHUs. PHU staff check new notifications on WANIDD daily, and prioritise and discuss any new syphilis notifications with the medical officer to verify the case and treatment required. Identifying a new case on WANIDD will also trigger a phone call from the PHU to the relevant service provider. As laboratories report on test results only, they may miss early cases of infectious syphilis. PHUs therefore also rely on clinicians to notify on the basis of clinical findings to trigger a response and particularly to ensure early cases are not missed.
When the PHU contacts the doctor or health worker who saw the patient, they enquire about whether the testing occurred in response to symptoms, which are then detailed. Alternatively it could have been part of asymptomatic screening. In the case of a symptomatic patient they may have already had treatment and enquired about contacts. However often there is treatment for another STI, and the patient needs to be recalled for treatment for syphilis. At this time it is important to give gentle but detailed questioning on sexual contacts. The time period enquired about for contacts is guided by the patient’s recall of a likely chancre or rash or other symptoms, indicating a time period when they likely were infected. Often it is helpful to guide the health worker or doctor with a questionnaire that can be used not only for patients with positive serology, but also for their contacts.
A state-wide syphilis register is currently not available in WA. However, the establishment of a syphilis register is under active consideration.
- Western Australia: https://ww2.health.wa.gov.au/Silver-book/STI-or-HIV-notification