Syphilis dramatically on the rise in Victoria: Report

Rates of syphilis have almost tripled since 2014, according to the Victorian government’s infectious disease surveillance report.
 
Melbourne City Council recorded the highest outbreak, with 141 reported cases, up from 47 in 2014.
 
Associate Professor Marcus Chen from the Melbourne Sexual Health Centre told newsGP these results are alarming.
 
‘It’s a serious public health problem, there’s no question about that,’ he said. ‘It is a dramatic rise.
 
‘If you look at the notifications in Victoria, they really show the reported cases going up relentlessly.’
 
Associate Professor Chen said there has been an ‘ongoing epidemic’ recently of syphilis in remote Aboriginal and Torres Strait Islander communities, from Queensland through central Australia.
 
‘But in terms of urban areas, I think right now probably Victoria is the worst affected,’ he said.
 
‘They may be seeing some increases in New South Wales, but I don’t think it’s to the same degree as Victoria.’
 
According to Associate Professor Chen, the most significant change in notifications has been the increasing number of women, particularly of reproductive age, who have contracted the infection.
 
Data shows that syphilis was largely detected in men who had sex with men before 2014.
 
‘Women in their 20s and 30s, and some in their 40s [who contracted syphilis], that’s really gone up exponentially,’ Associate Professor Chen said.
 
‘So if you go back to 2014, there were just a handful of cases [in women]. Over the last couple of years – 2018, 2019 – there’s probably over 150 women in Victoria with early syphilis.’
 
This is particularly concerning because of the correlated rise in congenital syphilis, a preventable, yet potentially lethal, condition.
 
‘That’s translated into at least four confirmed cases of congenital syphilis, which hasn’t been seen in Victoria since … 2004,’ Associate Professor Chen said.
 
‘When you see congenital syphilis, that’s really a case that syphilis controls have broken down because it’s so preventable.’


Associate Professor Marcus Chen hopes that raising awareness of the prevalence of syphilis will encourage practitioners to consider a diagnosis more frequently in all patients.

Associate Professor Chen said there is growing speculation as to whether sexual promiscuity is behind this surge in cases of syphilis.
 
‘Obviously it’s sexually transmitted, but there’s no data to suggest sexual behaviour has dramatically changed to account for that increase in number,’ he said.
 
Instead, Associate Professor Chen believes there may be an issue relating to testing for and treating the condition.
 
Traditionally, the spread of syphilis has been curtailed through serological testing and treatment, along with partner tracing and treatment, Associate Professor Chen said.
 
‘That generally should work if you’re doing enough of it,’ he said.
 
‘So from our perspective, we think that could be part of the problem, that that’s not really being done.’
 
Associate Professor Chen said lack of awareness of the prevalence of the infection may be fuelling that problem.
 
‘It’s not surprising, because there’s actually very little awareness out there about syphilis being a problem, per se, let alone heterosexual people being affected and the need for screening sexually active people,’ he said.
 
These findings serve to highlight a need for further screening and treatment.
 
‘What we’re trying to emphasise is the need for screening for sexually active men and women, and particularly pregnant women,’ Associate Professor Chen said.
 
Currently, pregnant women are universally screened for syphilis serologically at their first antenatal visit.
 
‘But what really needs to happen is that those women who are sexually active during pregnancy should be re-screened towards the end of pregnancy because they can actually acquire syphilis during pregnancy, and if they’re still infected at the end of pregnancy, there’s a risk of transmission to the child,’ he said.
 
Associate Professor Chen hopes that raising awareness of the prevalence of syphilis will encourage practitioners to consider a diagnosis more frequently in all patients, particularly those who are pregnant.
 
‘If someone presents with a genital lesion, an ulcer, think about primary syphilis, and do a swab,’ he said.
 
‘If they’ve got a generalised rash, just think, “Could that be syphilis, rather than psoriasis or something like that?”
 
‘More importantly, if they have young sexually active men and women, routinely do an STI screen that includes tests for gonorrhoea but also blood tests for syphilis and HIV.
 
‘And if syphilis is detected, make sure they give the right penicillin, which is Benzathine penicillin, if the person’s not allergic.
 
‘Because… there have been cases where the wrong penicillin’s been given and [practitioners] should be aware of that.’
 
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sexual health STI syphilis