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Syphilis is making a comeback: What GPs need to know


newsGP writers


14/04/2021 4:26:54 PM

A steady rise in cases has put screening for what had become a rare STI back on the agenda.

Female GP with a patient
A lack of awareness – among doctors and – may have contributed to the increase in Australian syphilis cases.

This article was first published by Jean Hailes and is reproduced with their permission.

There has been a rise in the number of cases of syphilis in Australia, especially among women of reproductive age (15–44).
 
Chief Medical Officer Professor Paul Kelly says women in this age group account for around 90% of all female cases diagnosed each year, and the added concern with women of child-bearing age contracting syphilis means their baby is also at risk that if they fall pregnant.
 
Syphilis can lead not only to babies being born with the infection (congenital syphilis), but can also cause miscarriage and stillbirth.
 
Professor Kelly is therefore urging doctors to take a sexual history from all their patients and to consider that infectious syphilis is possible in any of their sexually active patients.
 
Jean Hailes women’s health GP Dr Dominique Baume believes a lack of awareness – not just among doctors, but the wider community – has likely contributed to the increase in cases. However, that is now changing because of the current outbreak.
 
‘Syphilis is often thought of as a rare condition, but actually the rates have almost tripled in Australia since 2014,’ Dr Baume said.

What is syphilis?
Syphilis is a sexually transmissible infection (STI) that can cause serious damage to the body if not treated. It is, however, easy to treat and cure with antibiotics if found early.
 
Its symptoms can include a red rash on the hands, back, chest or feet, a high temperature, swollen glands, hair loss and tiredness. Others will notice a painless sore in the mouth, genital or anal areas. Sometimes a person will not even be aware of the sore because it is not painful.
 
While there has been an ongoing outbreak of syphilis in some Aboriginal and Torres Strait Islander communities in regional, remote and very remote areas of Queensland, the Northern Territory, Western Australia, and South Australia, increasing cases are now being detected in the broader population in major Australian cities.
 
Congenital syphilis occurs when the infection is passed on during pregnancy from a mother to her unborn baby.
 
However, most cases of syphilis that occur during pregnancy have no symptoms, according to Professor Basil Donovan, head of the Sexual Health Program at the Kirby Institute, an organisation dedicated to the prevention and treatment of infectious disease.
 
‘For pregnant women, this can be catastrophic,’ says Professor Donovan.

Why the rise in cases?
Professor Donovan says that over the past 20 years young people have become more relaxed about the risks of HIV, which in turn had led to them becoming less vigilant about the risk of contracting other STIs.

He says while HIV ‘had put the brakes on’ risky sexual behaviour, lowering STI infection rates, those rates were ‘now rebounding towards where we were before HIV.’ Professor Donovan  believes it is important to remember that syphilis can be transmitted through oral as well as vaginal sex.

‘[Young women] are still using condoms more than their parents or grandparents did in the pre-AIDS era, but [they] have more sexual partners than a decade ago,’ he said.

Less testing
Professor Donovan says many doctors had stopped testing for syphilis because it had become so rare. The infection can be detected with a blood test.

‘If syphilis tests were done as regularly as HIV [tests], detection rates would be higher and that would go a substantial way to bringing the problem under control,’ he said. ‘If you have genital ulcers, the doctor will think herpes and not test for syphilis.

‘We need to revive awareness among women.’

Dr Baume believes women can benefit from asking ask about syphilis testing during all routine STI checks. They should also be offered STI testing with antenatal booking blood tests. She says women are largely very aware of good sexual health practices, especially around contraception.

‘It can be easy to occasionally forget to use condoms, and even when used regularly they are not a foolproof method of preventing STIs,’ she says.

‘Syphilis is also frequently asymptomatic and so can go unnoticed for many years. That is why screening is so important with a yearly sexual health check-up in young people, and more often in at-risk groups.’

Screening is also advised for anyone of any age with a new partner.

Annual sexual health checks
Dr Baume would like to see women in reproductive years have STI screening as part of a pre-conception check-up, and at the first pregnancy visit. This may be repeated later in pregnancy if a woman is in an at-risk group.

She feels that as syphilis can often not show symptoms for years, screening for it also remains important beyond a woman’s child-bearing years.

‘As syphilis can be latent [not yet showing symptoms] for many years, screening is still important in women past their reproductive years and should be considered as part of a general women’s health check every year,’ she said.

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