Sexually Transmitted Diseases 2023

Sexually Transmitted Diseases, Publish Ahead of Print
DOI: 10.1097/OLQ.0000000000001825
The Re-emergence of Syphilis Among Females of Reproductive Age and
Congenital Syphilis in Victoria, Australia, 2010-2020: A Public Health
Priority
Sarah Borg, MBBS 1
Naveen Tenneti, MBBS 1
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Alvin Lee, MPH 1
George Drewett, MBBS 1
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Mihaela Ivan, MD 1
Michelle L Giles, PhD 2,3
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Victorian Department of Health, Melbourne, VIC, Australia
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Infectious Diseases Unit, Alfred Hospital, VIC, Australia
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Department of Infectious Diseases, Melbourne Medical School, The University of
Melbourne, VIC, Australia

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Correspondence
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Dr Sarah Borg
Victorian Department of Health

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50 Lonsdale St, Melbourne VIC 3000, Australia
Phone: 1300 650 172
Fax: N/A
Email: sarahannborg@gmail.com
Copyright © 2023 by the American Sexually Transmitted Diseases Association. Unauthorized reproduction of this article is prohibited.
Conflicts of interest and sources of funding
All authors declare no conflicts of interest. No funding was received for this research.
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Short summary
Rates of infectious syphilis in females of reproductive age and congenital syphilis are
increasing in Victoria, Australia. Most females are diagnosed in primary care, prior to
pregnancy.
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ABSTRACT
Background
Syphilis notifications in Victoria, Australia have been increasing over the past decade, with
an increase in infectious syphilis (syphilis of less than two years duration) cases in females of
reproductive age, and an associated re-emergence of congenital syphilis (CS). Prior to 2017
there had been two CS cases in the preceding 26 years. This study describes the
epidemiology of infectious syphilis among females of reproductive age and CS in Victoria.
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Methods
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Routine surveillance data provided by mandatory Victorian syphilis case notifications were
extracted and grouped into a descriptive analysis of infectious syphilis and CS incidence data
from 2010-20.
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Results
In 2020, infectious syphilis notifications in Victoria were approximately five times more than
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2010 (n=289 in 2010 to n=1440 in 2020), with a more than seven-fold rise among females
(n=25 in 2010 to n=186 in 2020). Females made up 29% (n=60/209) of Aboriginal and
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Torres Strait Islander notifications occurring between 2010-2020. Between 2017-2020, 67%
of notifications in females (n=456/678) were diagnosed in low-caseload clinics, at least 13%

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(n=87/678) of all female notifications were known to be pregnant at diagnosis, and there were
nine CS notifications.
Conclusions
Cases of infectious syphilis in females of reproductive age and CS are on the rise in Victoria,
necessitating sustained public health action. Increasing awareness among individuals and
clinicians, and health system strengthening, particularly targeting primary care where most
females are diagnosed prior to pregnancy, is required. Treating infections before or promptly
during pregnancy and undertaking partner notification and treatment to reduce risk of
reinfection is critical to reducing CS cases.
Key words: Syphilis, congenital syphilis, epidemiology, sexually transmitted infections,
sexual and reproductive health,
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INTRODUCTION
Syphilis is an infection caused by Treponema pallidum that, if untreated, can result in
substantial morbidity (1, 2). Syphilis is transmitted through sexual contact, blood transfusion,
or transplacentally from a pregnant female to her fetus (congenital syphilis (CS)). Infectious
syphilis is defined as syphilis of less than two years duration, during which approximate time
syphilis is considered infectious, if untreated (3). Late syphilis is defined as an infection
acquired more than two years ago or at an unknown time. Syphilis is often asymptomatic (4)
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and if there are symptoms these are commonly unrecognised and/or misdiagnosed by
healthcare providers, particularly as symptoms and signs can be clinically mild or atypical
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(5). Thus, asymptomatic screening is important for detection and timely treatment (6). CS
occurs when the infection is transmitted from a pregnant female to the fetus. Transmission of
syphilis is can be devastating to the fetus if maternal infection is not detected and not
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effectively treated early in pregnancy (2). Untreated syphilis in pregnant females may result
in stillbirth (7), prematurity or a wide spectrum of clinical manifestations (7, 8). Syphilis in
pregnancy can be safely treated with antibiotics, which can prevent these complications (1).
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Since the early 2000s, high-income countries have observed rising syphilis rates among
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people at high risk, such as men who have sex with men (MSM), who may experience poorer
healthcare access and utilisation as a result of discrimination, stigma and underinvestment in

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public health services (9). High syphilis prevalence within groups engaging in high-risk
sexual behaviours may occur, further increasing the probability of exposure to infection with
each sexual encounter (10). Recent increases in syphilis cases among heterosexual males and
females in countries, including Japan, the United States, Canada, and in Western Europe have
raised concerns around the risk of mother-to-child transmission (9, 11-13). Similarly,
infectious syphilis notification rates in Australia have been steadily increasing over the last
decade (9). Syphilis is a notifiable disease in Australia, meaning that state and territory health
authorities are required to supply the National Notifiable Diseases Surveillance System
(within the Commonwealth of Australia’s Department of Health and Aged Care) with de-
identified notification data about new cases. Notifications come from various sources,
including clinicians, laboratories and hospitals (14). Between 2011 and 2019, the notification
rate of infectious syphilis in Australia increased fourfold from 6.0 per 100,000 in 2011 (10.4
and 1.7 per 100,000 in males and females, respectively) to 24.0 per 100,000 (39.8 and 8.1 per
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100,000 in males and females, respectively) in 2019 (15) , with an almost fourfold and
fivefold increase in males and females, respectively (12). In 2019, rates of infectious syphilis
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among Aboriginal and Torres Strait Islander peoples (122.0 per 100,000) were six times
higher than in the non-Indigenous population (20.4 per 100,000) (15). In 2019 the rate of
notification for infectious syphilis among Aboriginal and Torres Strait Islander females was
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119.7 per 100,000, 30 times greater than the rate for non-Indigenous females of 3.9 per
100,000 (16). Increasing rates of notification among females of reproductive age increases
the risk for CS. In countries such as Japan and the United States, increasing rates of CS have
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already been observed (11). Australian national guidelines recommend routine syphilis
testing at the first antenatal contact for all pregnant females, and re-testing in the third
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trimester and at birth for those at high risk of infection or reinfection (1). Australia remains a
country with low prevalence for CS. However, after a decline in notifications between 2005
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and 2010, the number of CS cases is on the rise, mirroring an increase in infections in
females (9, 12). Between 2011 and 2020 there were 58 CS notifications in Australia, with
more than half (53%, n=31) among the Aboriginal and Torres Strait Islander population (15).
Prior to 2017 there had only been two cases of CS in Victoria, a state in Australia, in the
preceding 26 years (one in 1998 and one in 2004) (17).
The purpose of this study is to describe the recent epidemiology of infectious syphilis and CS
in Victoria and examine the characteristics of notified cases, with a focus on cases in females.
Utilising enhanced surveillance data, we aim to better understand the factors which may be
driving the rising rates of infectious syphilis in females of reproductive age and help inform
targeted public health control measures to address this rising burden of disease.
MATERIALS AND METHODS
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Under the Public Health and Wellbeing Act 2008, medical practitioners and pathology
services in Victoria must provide written notification of syphilis cases to the Victorian
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Department of Health (18). Notification is required for both confirmed and probable CS
cases, including syphilis-related stillbirth. A confirmed CS case requires laboratory definitive
evidence, and a probable CS case requires laboratory suggestive evidence and clinical
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evidence (3). In addition, the Department of Health has conducted enhanced surveillance on
syphilis notifications since 2016 by requesting the diagnosing doctor to complete and return a
questionnaire with additional demographic and risk factor data to help further inform public
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health action (18). In 2017 pregnancy status was added to the enhanced surveillance form and
all CS cases have since been followed up by the Department of Health to determine further
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case details from the diagnosing doctor.

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All de-identified notification and enhanced surveillance data are entered into the Victorian
Public Health Event Surveillance System (PHESS). Victorian infectious syphilis, late
syphilis, and CS notification data from 2010-20 was extracted from PHESS. From 2010-2020
data on sex, age, and Aboriginal and Torres Strait Islander status were available for infectious
syphilis notifications. In 2016 country of birth was added, and from 2017, diagnosing clinic
type, pregnancy status, likely source of acquisition, and reason for testing for pregnant cases
were added for infectious syphilis. For CS, in 2017, data on country of birth, Aboriginal and
Torres Strait Islander status, and likely source of acquisition of the mother, and clinical
complications of cases were added.
This study includes a descriptive analysis of surveillance data collected by the Victorian
Department of Health to inform public health action as per the Victorian Public Health and
Wellbeing Act 2008 (19). This manuscript undertook a departmental approval process prior to
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submission for publication, and ethics approval was not required in this instance.
RESULTS
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Infectious Syphilis in Victoria
Total syphilis notifications in Victoria increased between 2010-2020, with a greater

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proportional increase in infectious syphilis notifications. Infectious syphilis notifications
made up 33% (n=289/868) of total syphilis notifications in 2010, and 64% (n=1435/2250) in
2020. There were 10,247 infectious syphilis notifications in Victoria between 2010-2020,
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with annual notifications rising steadily over the past decade (Figure 1). In 2019 Victoria had
the highest number of infectious syphilis notifications ever recorded (n=1664), with a rate of
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28.1 notifications per 100,000 population. Infectious syphilis notification rates in males (51.1
per 100,000) were substantially higher than in females (5.9 per 100,000) in 2019 (Figure 1).
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Between 2010-2020, 9% (n=964/10,257) of infectious syphilis notifications were in females,
and the majority (95%, n=915/964) of female notifications occurred in females of
reproductive age (15-49 years) (Figure 2). In 2019, 97% (n=171/177) of female cases
occurred in females of reproductive age (15-49 years), with a higher notification rate (11.8
per 100,000) than for total female case notifications (5.9 per 100,000). In the last five years,
infectious syphilis notifications in all females (n=99 in 2016 to n=184 in 2020), and females
of reproductive age (n=94 in 2016 to n=177 in 2020) almost doubled. There were 184 cases
among females in 2020, representing a more than seven-fold rise when compared with 2010
notification data (n=25). During this same period an almost five-fold rise was observed
among males (n=264 in 2010 to n=1251 in 2020).
Almost three quarters (71%, n=553/777) of cases of infectious syphilis between 2016-20 in
females and 63% (n=3388/6165) in males were Australian born.
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Between 2017-2020 in Victoria, 73% of notifications in MSM (n=2582/3536) were primarily
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diagnosed through high-caseload clinics (sexual health and general practice clinics that see
high caseloads of sexual health patients), often in inner metropolitan areas, and only 20%
(n=713/3536) were diagnosed through low-caseload clinics (all other non-hospital clinical
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settings that syphilis notifications are sent from). In contrast, 67% (n=456/678) of female
notifications and 59% (n=455/765) of heterosexual male notifications were primarily
diagnosed through low-caseload clinics across the state. Similarly, low-caseload clinics
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predominately diagnosed Aboriginal and Torres Strait Islander peoples (63%, n=30/48 of
females and 36%, n=34/95 of men).

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Infectious Syphilis in Aboriginal and Torres Strait Islander Peoples in Victoria

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Among Aboriginal and Torres Strait Islander people in Victoria, there has been a significant
increase in notifications since 2013 among males, and since 2015 among females. A drop in
male and female notifications occurred in 2020, which may reflect changes in testing rates
during the COVID-19 pandemic.
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The rate of infectious syphilis in Aboriginal and Torres Strait Islander peoples was higher
than in the general population in every year from 2013-2020, with the highest rates occurring
in 2019. The rate for males, females, and females of reproductive age in 2019 was 127.0,
66.2 and 134.4 per 100,000 population respectively in Aboriginal and Torres Strait Islander
peoples. In contrast, the rate for males, females, and females of reproductive age in the
general population in 2019 was 51.1, 5.9 and 11.8 per 100,000 population respectively.
Females constituted 29% (n=60/209) of cases in Aboriginal and Torres Strait Islander
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peoples between 2010-2020 (compared to 9% (n=964/10257) of female cases in the general
population).
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Infectious Syphilis in Pregnant Females in Victoria
Thirteen percent (n=87/678) of infectious syphilis notifications in females (of all ages)
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between 2017-2020 were pregnant at the time of diagnosis (Figure 3). The highest number of
female notifications that were pregnant at diagnosis (18%, n=31/177) during this time
occurred in 2019.
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Between 2017-2020 one third (n=30/87, 34%) of females pregnant at the time of diagnosis
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reported their regular partner as the likely source of infection. Most females pregnant at the
time of diagnosis during this time were detected through antenatal screening (n=53/87, 61%).
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Only 7% (n=6/87) of cases were tested because they were experiencing symptoms of
syphilis, and 6% (n=5/87) were tested because they requested testing. Other reasons for
testing were: suggested by the doctor (5%, n=4/87), “other/multiple” (21%, n=18/87), and
“unknown” (1%, n=1/87).
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Congenital Syphilis in Victoria
CS re-emerged in Victoria in 2017. Prior to 2017 there had only been two cases in the
preceding 26 years (one in 1998 and one in 2004). There have been nine cases meeting the
probable or confirmed CS case definition in Victoria between 2017 and 2020. Among these
cases, four were stillbirths and five had complications of syphilis at birth. Two Victorian
mothers of CS cases were born overseas, seven were Australian born, and one identified as
Aboriginal or Torres Strait Islander. Mothers of three cases did not receive any antenatal care
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and were diagnosed at delivery. Mothers of six cases received at least one antenatal care
appointment and had negative syphilis serology on early pregnancy screening blood tests,
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with maternal infection being acquired later during pregnancy. Of these, three were
diagnosed at delivery, and three were diagnosed post-delivery (two when the baby presented
with CS symptoms, and one when identified as a contact of a syphilis case).

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DISCUSSION
Infectious syphilis notifications have increased considerably in Victoria over the past decade.
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It is concerning to observe the increase in heterosexual males and females, including females
of reproductive age, and an increase in notifications of CS, with a disproportional burden of

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infectious syphilis notifications affecting Aboriginal and Torres Strait Islander peoples. The
change in epidemological picture in Victoria is largely reflective of the national data (9, 12,
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15). In response, the Victorian Department of Health has implemented a coordinated public
health response which includes enhanced surveillance, intensive follow-up of cases in
pregnancy and a comprehensive communication strategy. Our data may help identify where
further public health efforts in Victoria should be focused.
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Most pregnant females diagnosed with syphilis were detected through antenatal screening
(61%). Only 7% of females pregnant at time of diagnosis were tested because they were
experiencing symptoms of syphilis. This emphasises the importance of raising awareness and
screening to detect infectious syphilis in pregnant females, especially those who have non-
specific symptoms that may reflect infection. Adequate antenatal screening is crucial for
detecting maternal infection and improving infant outcomes (1, 8). Treatment of syphilis in
pregnancy reduces the incidence of CS by 97%, stillbirth by 82%, preterm birth by 64% and
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neonatal deaths by 80% (8).
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Victoria follows national guidelines which recommend routine syphilis testing at the first
antenatal contact for all pregnant females (1, 8). Re-testing in the third trimester and at birth
in Victoria is usually only offered to pregnant females considered at high risk of infection or
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reinfection (1, 8). However, as infectious syphilis and CS cases continue to rise, there may be
a need to extend and reconsider definitions of ‘high-risk’. A female is considered at high risk
of syphilis in pregnancy if: she or her partner live in a declared outbreak area or an area of
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known high prevalence, she has a current or recent STI, has previously had infectious
syphilis in pregnancy, or engages in intravenous substance use during pregnancy. However,

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there are factors that increase the risk of syphilis which females may not be aware of,
including: if she is a sexual contact of a person with infectious syphilis, has unprotected
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vaginal, oral or anal sex with a male partner at high risk of having syphilis, has a male sexual
partner who has sex with men, or, she and/or her partner(s) have sexual partners from high
prevalence countries (1). If females are not aware that their sexual partner has, or is at higher
risk of having syphilis, they may not be offered additional antenatal screening to detect
syphilis acquisition later in pregnancy.
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Whilst antenatal testing is important, it cannot be solely relied upon. Increased efforts need to
target primary care and particularly females of reproductive age prior to pregnancy. The
reason for this is that 67% of females are diagnosed in this context (in low-caseload clinics)
versus 12% diagnosed in hospital and 11% diagnosed in high-caseload clinics. If females of
reproductive age with syphilis are screened and diagnosed, receive adequate treatment, and
avoid reinfection (which can be aided through contact tracing and partner notification and
treatment) then this can help eliminate the risk of CS occurring in pregnancy. Adequate
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antenatal testing is dependent on attending for antenatal care. Similar to non-Indigenous
females, most Aboriginal and Torres Strait Islander females of reproductive age, are also
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diagnosed in low-caseload clinics (63%) and are less likely to attend an antenatal visit in the
first trimester compared to non-Indigenous females (53% versus 60%), so detecting cases
prior to pregnancy remains a priority in this population (20). Previous experiences of

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institutional racism in healthcare settings and lack of culturally safe care contribute to
disparities in health service use and access for Aboriginal and Torres Strait Islander people in
Australia. Ensuring sexual health service provision is culturally safe can improve healthcare
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access and quality (21). Prioritising cultural safety training for healthcare practitioners and
encouraging liaison with Aboriginal and Torres Strait Islander Health Workers, Health
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Practitioners and/or Hospital Liaison Officers can assist improvements in healthcare
provision for Aboriginal and Torres Strait Islander mothers and their babies (20, 22), which
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may aid in prevention of congenital syphilis cases. Ensuring primary care provision is
inclusive and culturally safe, will help to reduce barriers in accessing sexual health care
experienced by Aboriginal and Torres Strait Islander and lesbian, gay, bisexual, trans and
gender diverse, intersex, and queer (LGBTIQ+) communities, and address health disparities.
Promotion of healthcare practitioner training in inclusive healthcare provision for LGBTIQ+
Victorians, incorporating communication with patients from diverse cultural backgrounds
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and gender or sexual identities, focusing on intersectional sexual health is required (23), and
has been shown to improve healthcare practitioner confidence in approaching cross-cultural
patient interactions (24).
Raising community awareness about the increase of cases in heterosexual populations in
Victoria, the associated risks of syphilis in pregnancy, transmission, and the importance of
prevention and screening will help individuals make informed decisions to minimise impact
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to their health and safety. Raising community awareness of syphilis has been found to
increase testing (25, 26). Given the high rates of infectious syphilis in Aboriginal and Torres
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Strait Islander peoples, particularly women of reproductive age, tailored and culturally safe
engagement with Aboriginal and Torres Strait Islander communities through the Aboriginal
Community Controlled Health Sector is also required.

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Regular partners were the most reported likely source of acquisition for cases in females
pregnant at time of diagnosis and mothers of CS cases in Victoria. This highlights the
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importance of partner notification and treating sexual partner(s) to avoid reinfection and
ongoing transmission (1). Adequate contact tracing of sexual partners is a key step in syphilis
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outbreak management (27).

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It is important to consider the limitations of our data. It is recognised that some syphilis cases
may remain undiagnosed, particularly asymptomatic cases in the early stage of the infection,
and are not notified to the Department of Health. Data from enhanced surveillance may be
subject to recall bias from healthcare providers, and while enhanced surveillance data is
available for over 90% of infectious syphilis notifications, incomplete forms from healthcare
providers continues to be an issue. Data such as clinical presentation of cases were not
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included in the descriptive analysis due to incomplete enhanced surveillance forms and lack
of confidence in validity of the questionnaire to adequately capture this data. Furthermore,
true case numbers in 2020 were likely underreported due to reduced sexually transmitted
infection testing because of the COVID-19 pandemic, so data from 2020 should be
interpreted with caution. A consistent decline in the notification rate for infectious syphilis
and other STIs was also observed nationally between 2019 and 2021 (28), with a decline in
asymptomatic syphilis testing noted in 2019 (29). A study of consultations at the largest
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public sexual health service in Victoria in the first half of 2020 found a 68% reduction in
asymptomatic STI screening during COVID-19 lockdown (30). Finally in 2015, the
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Communicable Disease Network of Australia case definition for infectious syphilis changed
to include “probable” cases (31). This change may have contributed to the increase in
infectious syphilis cases notified in Victoria from 2015-16. However, there has been a steady
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rise of cases from 2016 regardless.
The increasing rate of infectious syphilis in females in Victoria and the subsequent re-
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emergence of CS, requires urgent and sustained public health action. CS is entirely
preventable and its occurrence represents a failure of the health system (3). Treating
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infections before or promptly during pregnancy and undertaking partner notification and
treatment to reduce risk of reinfection is critical to eliminating CS. Increasing awareness

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among individuals and healthcare providers, and health system strengthening, particularly
targeting primary care where most females are diagnosed prior to pregnancy, is required.
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https://kirby.unsw.edu.au/report/asr2022
29. Carter A, McManus H, Ward JS, et al. Infectious syphilis in women and heterosexual
men in major Australian cities: sentinel surveillance data, 2011–2019. Med J Aust.
2023;218(5):223-8.
D
30. Chow EP, Hocking JS, Ong JJ, et al. Sexually Transmitted Infection Diagnoses and
Access to a Sexual Health Service Before and After the National Lockdown for
31.
TE
COVID-19 in Melbourne, Australia. Open Forum Infect Dis. 2021;8(1):ofaa536.
Australian Government Department of Health. Syphilis - infectious (primary,
secondary and early latent), less than 2 years duration case definition: Commonwealth
EP
of Australia; 2016. [Access date: 2023 Mar 30]. Available from:
https://www1.health.gov.au/internet/main/publishing.nsf/Content/cda-surveil-nndss-
casedefs-cd_syphl2.htm.
C
C
A
21
FIGURES
1800 60.0
1600 51.1
50.0
1400
43.0
41.0 41.5
1200 40.0
D
Rate (per 100,000 population)
Number of Case Notifications
35.4
1000 30.9
TE
1,487 30.0
800 1,251
1,207
1,191
21.2 21.3
600 1,029 20.0

EP
15.0 900
400
10.0 617
9.1 619
10.0
436 5.9 6.1
200 292 5.0 5.5
264
3.3
C
1.0 1.2 1.7 177 184

0.8 1.0 0.6 152 165
99
25 30 29 36 17 50
0 0.0
2010 2011 2012 2013 2014 2015 2016 2017 2018 2019 2020
Year of Notification
C
Figure 1: Infectious Syphilis Notifications in Victoria by Sex, 2010 – 2020

A
22
2500
2000
D
Number of Infectious Syphilis Case Notifications
TE
1500
1679
EP
1000 1663
1355
936 1087
C
1003
500
676
C
401
110 184 226 219

167 126 100 57 102
A
55 22 14 35 13 11
0 2
0 4 3 1 2 2 1
10-14 15-19 20-24 25-29 30-34 35-39 40-44 45-49 50-54 55-59 60-64 65-69 70-74 75-79 80-84 85+
Five-Year Age Group
Female Cases Male Cases
Figure 2: Infectious Syphilis Notifications in Victoria by Five-Year Age Group and Sex,
2010-2020
23
200
180
160 26 42
140 43
31
Number of Cases
41 26
120
19
11
100 Unknown
80 Pregnant
60 120 116 Not pregnant

100 103
40
20
D
0
2017 2018 2019 2020
Year of Notification
TE
Figure 3: Infectious Syphilis Notifications in Females in Victoria by Pregnancy Status,
2017-2020
EP
C
C
A
24

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Sexually Transmitted Diseases, Publish Ahead of Print

The Re-emergence of Syphilis Among Females of Reproductive Age and

Congenital Syphilis in Victoria, Australia, 2010-2020: A Public Health

Sarah Borg, MBBS 1

Naveen Tenneti, MBBS 1

George Drewett, MBBS 1

Michelle L Giles, PhD 2,3

Melbourne, VIC, Australia

Victorian Department of Health

50 Lonsdale St, Melbourne VIC 3000, Australia

Phone: 1300 650 172

epidemiology of infectious syphilis among females of reproductive age and CS in Victoria.

of notifications in females (n=456/678) were diagnosed in low-caseload clinics, at least 13%

reinfection is critical to reducing CS cases.

Key words: Syphilis, congenital syphilis, epidemiology, sexually transmitted infections,

sexual and reproductive health,

Syphilis is an infection caused by Treponema pallidum that, if untreated, can result in

syphilis is considered infectious, if untreated (3). Late syphilis is defined as an infection

healthcare access and utilisation as a result of discrimination, stigma and underinvestment in

preceding 26 years (one in 1998 and one in 2004) (17).

MATERIALS AND METHODS

cases, including syphilis-related stillbirth. A confirmed CS case requires laboratory definitive

case details from the diagnosing doctor.

complications of cases were added.

Total syphilis notifications in Victoria increased between 2010-2020, with a greater

Between 2010-2020, 9% (n=964/10,257) of infectious syphilis notifications were in females,

and the majority (95%, n=915/964) of female notifications occurred in females of

among males (n=264 in 2010 to n=1251 in 2020).

females and 63% (n=3388/6165) in males were Australian born.

notifications and 59% (n=455/765) of heterosexual male notifications were primarily

females and 36%, n=34/95 of men).

Infectious Syphilis in Aboriginal and Torres Strait Islander Peoples in Victoria

during the COVID-19 pandemic.

“unknown” (1%, n=1/87).

with CS symptoms, and one when identified as a contact of a syphilis case).

of reproductive age, and an increase in notifications of CS, with a disproportional burden of

health response which includes enhanced surveillance, intensive follow-up of cases in

further public health efforts in Victoria should be focused.

syphilis in pregnancy, or engages in intravenous substance use during pregnancy. However,

syphilis acquisition later in pregnancy.

prior to pregnancy remains a priority in this population (20). Previous experiences of

Practitioners and/or Hospital Liaison Officers can assist improvements in healthcare

Promotion of healthcare practitioner training in inclusive healthcare provision for LGBTIQ+

Victorians, incorporating communication with patients from diverse cultural backgrounds

has been shown to improve healthcare practitioner confidence in approaching cross-cultural

patient interactions (24).

Raising community awareness about the increase of cases in heterosexual populations in

Community Controlled Health Sector is also required.

outbreak management (27).

of confidence in validity of the questionnaire to adequately capture this data. Furthermore,

treatment to reduce risk of reinfection is critical to eliminating CS. Increasing awareness

1. Australian Government Department of Health. Pregnancy Care Guidelines: Syphilis:

2. World Health Organization. WHO guidelines for the treatment of Treponema

3. Communicable Diseases Network of Australia. CDNA National Guidelines for Public

Mar 30]. Available

Reduction in Secondary Syphilis. Clin Infect Dis. 2017;65(3):389–95.

common in men with Treponema pallidum PCR-positive primary syphilis without

herpes simplex virus coinfection: a cross-sectional clinic-based study. Sex Transm

Infect Dis 2011;57–58:57–8.

PLoS One. 2014;9(7):e102203.

treatment of syphilis in pregnancy to reduce syphilis related stillbirths and neonatal

mortality. BMC Public Health. 2011;11(S9).

9. Kojima N, Klausner J. An Update on the Global Epidemiology of Syphilis. Curr

Spiteri G, Unemo M, Mårdh O, et al. The resurgence of syphilis in high-income