New clinical tool to aid syphilis management

Morgan Liotta

15/03/2023 4:56:49 PM

With rates of the STI rising, integrating the tool into clinical practice could help identify which patients need urgent treatment.

Blood test
A new clinical tool provides a quick reference resource for primary care providers to support their testing and treatment of syphilis.

Australia is experiencing an ‘epidemic’ of syphilis.
Once considered rare, infectious syphilis registered notification rates that peaked in 2019 at 23.9 per 100,000 population, and reached 22.7 in 2021, according to modelling from the Kirby Institute.

Additionally, in 2021 there were 5570 diagnoses of infectious syphilis compared to 5248 notifications in 2020.
To help address the rising cases in the sexually transmissible infection (STI), the Australasian Society for HIV, Viral Hepatitis and Sexual Health Medicine (ASHM) has launched a clinical Syphilis Interactive Tool.
The online decision-making tool is designed to support primary care providers testing for and treating syphilis and help them to navigate through any test result complexities.
Dr Nicholas Medland is a sexual health physician, senior researcher at the Kirby Institute and President of the ASHM Board.
He said that with a rise in syphilis cases across Australia, the tool’s release is timely.
‘We’ve seen a concerning increase in syphilis cases over the past decade, with particular spikes among several priority populations,’ he said.
‘Yet today, many clinicians think syphilis is rare. Many clinicians also find the tests used to treat syphilis confusing. This tool takes primary care doctors through the complexities of test results and supports decision making to identify which patients need urgent treatment.
‘This worrying rise in syphilis cases is a major public health challenge, with early detection and effective treatment presenting the best solutions to syphilis control.
‘That’s why we’ve launched this online Syphilis Interactive Tool. In less than 10 minutes, primary care professionals can be guided through the testing and treatment of syphilis for their patients.’
The World Health Organization has set a 2030 target for 50 or less cases of congenital syphilis per 100,000 live births in 80% of countries. While Australia has made notable progress in the management of STIs in recent years, including an increased number of young people vaccinated against human papillomavirus through its national program, it remains a public health challenge, with increased rates of syphilis an emerging issue.
Between 2011 and 2019, the infectious syphilis notification rate quadrupled from 6.0 to 24.0 per 100,000. A 12% decline was recorded between 2019 and 2020 to 21.2 per 100,000, with similar trends seen among males and females – with the Kirby Institute noting the 2020 decline was likely due to a pandemic-related decrease in testing rates.
Infectious syphilis notification rates in 2020 were four times as high among males than females, and highest among people aged 25–29 years and those living in remote areas.
RACGP Board Chair and GP representative on the Ministerial Advisory Committee on Blood-Borne Viruses and Sexually Transmitted Infections, Dr Lara Roeske, previously told newsGP that ‘the greatest opportunity’ for syphilis control through early detection and effective treatment is in general practice.
She also suggested there is limited awareness surrounding the prevalence and risk of syphilis, despite effective antibiotic treatments available.
‘There is an urgent need to alert GPs to the ongoing syphilis epidemic and the potentially lethal and catastrophic consequences of undiagnosed and untreated maternal infection, and congenital syphilis,’ Dr Roeske said.
‘Many GPs are unaware of the epidemic, and may lack the confidence, knowledge and skills to detect and treat syphilis. There are variable approaches to testing in the context of busy general practice, and most GPs lack current experience in managing syphilis.’
The Syphilis Interactive Tool also incorporates pathways for diagnosis and treatment during pregnancy, with the ASHM highlighting that this is a ‘priority population group of growing concern’ because of the risk of transmission to the unborn baby that can lead to congenital syphilis.
While Australia’s current prevalence of congenital syphilis is low, coinciding with peaks in infectious syphilis notifications, there has been an increase in syphilis rates among pregnant people from 5.9 to 23.2 per 100,000 between 2009 and 2019.
Other evidence supports the importance of early testing and identification for congenital syphilis, particularly in the general practice setting.
‘The increase in syphilis in [pregnant] women is particularly worrying,’ Dr Medland said.
‘It’s important that GPs are aware of this increase in cases. If a pregnant woman is not diagnosed and treated, congenital syphilis can have potentially devastating consequences.’
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