GPs urged to ‘test, treat, trace’ as congenital syphilis rates rise

Syphilis is no longer considered rare in Australia, with cases more than tripling over the last decade.

According to the latest figures, this includes a sixfold increase in the number of women diagnosed with the sexually transmitted infection.
 
If a woman with undiagnosed syphilis falls pregnant, or is infected during pregnancy, untreated syphilis can have serious impacts on her pregnancy and baby – including pre-term birth and neonatal death.
 
Sydney-based GP and specialist in sexual health medicine Dr Yen Li Lim told newsGP that primary care has a central role to play in preventing congenital syphilis and encourages all GPs to ‘test, treat, trace’ based on local guidelines.
 
‘Congenital syphilis is 100% preventable but rates are rising,’ she said.
 
‘It is important to screen for syphilis in all pregnant women and women of child-bearing age. Partners within the last three months should be contact traced and treated presumptively.’
 
Syphilis guidelines remain state- and territory-based. Depending on local outbreaks testing can be recommended anywhere between two and six times during the antenatal period.
 
‘As an example, in the standard population, NSW guidelines say to test people twice during pregnancy, but in Queensland syphilis guidelines actually suggest testing three or four times depending on the risk,’ Dr Lim said.
 
‘So you can test anywhere between three and six times depending on the person [and] the pre-test probability.
 
‘But at minimum we should test them twice, three times really if you get a prenatal visit.’
 
Sixty-nine cases of congenital syphilis cases have been recorded in the last seven years, with 18 of those cases resulting in infant death. Diagnosing syphilis with adequate time to treat the infection during pregnancy is necessary to prevent congenital syphilis.
 
‘You want to treat the pregnant woman with penicillin at least four weeks before delivery for it to be effective,’ Dr Lim said.
 
She encourages GPs to reach out to local public health services and utilise sexual health resources in their area if they receive a positive result.
 
Stigma and bias also play a role in under-testing and undertaking routine screening can alleviate the burden on time-poor GPs. Dr Lim says in pregnancy we tend to ‘take sex out of the equation – but actually, [pregnant women] could still be having sex, they could be having more partners’.
 
‘I know how hard it is to do all these things in 15 minutes, maybe only five minutes, maybe two minutes because it’s very difficult to cover all those bases,’ she said.
 
Benzathine benzylpenicillin remains the first-line treatment and is available at no cost through the Prescriber Bag. However, Dr Lim cautions that use should be prioritised for syphilis in pregnancy due to a current shortage of the medication.
 
GPs can refer to their local guidelines for further information on recommended antenatal screening frequency and timing, while state or territory public health authorities should be notified of all probable or confirmed cases.
 
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