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‘Urgent need’ to alert GPs of syphilis epidemic

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While Australia has made some notable progress in the management of sexually transmissible infections (STIs) in recent years, syphilis remains a significant public health challenge.
 
Cases are continuing to rise at an ‘alarming’ rate, and many may have gone undetected during the pandemic, according to sexual health expert and RACGP Specific Interests Chair, Dr Lara Roeske.
 
‘Over the past decade, the prevalence of infectious syphilis has continued to rise in several priority populations across the nation,’ she told newsGP.
 
‘COVID has obscured an emerging and alarming syphilis epidemic that has expanded across all of Australia, and as we emerge from the pandemic there will be more opportunities for travel, new sexual partners and casual sex.’
 
Recently seen in high numbers among young Aboriginal and Torres Strait Islander people aged 15–29 living in northern, central, western and southern Australia, the STI is also spreading in cities, with outbreaks in the Melbourne suburbs, where cases of gonorrhoea are also on the rise.
 
Dr Roeske says the statistics are concerning.
 
‘The geography of syphilis is changing,’ she said.
 
‘[It is] shifting from remote and rural northern Australia to large cities − notably Perth, Sydney and Melbourne, where there are current outbreaks.
 
‘Recently there have been significant changes in the epidemiology of syphilis in Australia. In the five-year interval between 2015 and 2020, syphilis notifications have increased by 350%, compared to 23% for chlamydia and 123% for gonorrhoea infections.’
 
Of great concern to Dr Roeske, is the 223% increase in the rates of infection in women of reproductive age, 15−44 years.
 
‘Younger women aged 15−24 years now have the largest increase in rates of new infection, an increase of about 2475%,’ she said.
 
These statistics, coupled with the thousands of health checks missed during COVID-related lockdowns and restrictions, mean ‘it has never been more important’ for GPs to know how to detect and treat syphilis.
 
‘Syphilis is a life-long disease affecting multiple organ systems if it is not diagnosed and treated,’ Dr Roeske said.
 
‘Re-infection with syphilis is possible and not uncommon. [The disease] has a number of catastrophic outcomes, including adverse pregnancy outcomes and neonatal death from congenital syphilis.
 
‘It is in general practice that the greatest opportunity exists for syphilis control through the early detection and effective treatment in the community.’
 
However, although syphilis can be effectively treated and cured with antibiotics, Dr Roeske believes there is limited awareness surrounding the current prevalence and risks of the disease.
 
‘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,’ she 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.’
 
An RACGP webinar on 23 March, facilitated by Dr Roeske, aims to address these gaps and put the STI back on GPs’ radar by examining their role in combatting the new epidemic.
 
‘There may be an incorrect perception among GPs that syphilis is rare – an infectious disease of a bygone era, confined to specific groups far removed from their own practices or to the archives of medical textbooks,’ Dr Roeske said.
 
‘[But] about two million Australians see a GP each week, and [around] 90% of STIs are diagnosed in primary care.
 
‘Therefore, GPs have a crucial role in reducing the prevalence of syphilis in the community through early diagnosis, testing and re-testing at risk patients, in addition to providing timely and appropriate antibiotic treatments.’
 
The webinar will aim to provide an important update on the specific skills and actions to improve prevention, detection and treatment of syphilis by GPs, including:

• comprehensive syphilis testing and treatment
• achieving earlier detection of primary, secondary, and asymptomatic infection
• opportunistic testing as part of the time-limited consultation
• preparedness for universal (up to five times) testing during and post-pregnancy
• how to test, screen and manage syphilis in a culturally appropriate and inclusive manner
• accessing clinical advice and support at point of care.

Dr Roeske said the webinar will also guide GPs in defining risk factors and identifying priority and high-risk groups in their practice, improve diagnosis of primary syphilis and the frequency of serological testing to detect very early syphilis.
 
‘[Participants] will learn from experts to correctly and consistently interpret a range of syphilis test results,’ she said.
 
‘A short video will show GPs how to safely administer treatment protocols, including long-acting penicillin injection, reducing pain of treatment and multiple treatments.
 
‘GPs will be able to better support women and their sexual health during pregnancy to reduce the risk of congenital syphilis and adverse pregnancy outcomes, and know how to access timely expert advice and clinical support.’
 
Recommendations to eliminate syphilis
In October 2021, the Department of Health’s Ministerial Advisory Committee on blood-borne viruses and sexually transmitted infections met at an all-day syphilis roundtable to discuss data and information about the epidemiology and geography of the disease in Australia, and establish recommendations to address the epidemic.
 
Recommendations from the committee include: 

• the development of advisory groups targeting at-risk populations,
• a national plan, including the introduction of a general practice ‘annual sexual health check’ MBS item to incentivise comprehensive STI testing and treatment by sexual health and primary care providers,
• support for early diagnosis. 

Dr Roeske, who is the RACGP representative on the committee, supports the recommendation that testing for syphilis and other STIs to be ‘a normal part’ of clinical and preventive care delivered by GPs, who can consider a sexual health check-up for all sexually active adults as part of an annual health check.
 
The committee confirmed that Australia is not on track to achieve elimination of infectious syphilis by 2030, as part of the World Health Organization’s strategy on elimination of STI epidemics by 2030 adopted by the Australian government.
 
GPs can register to attend the upcoming 23 March live webinar on the RACGP website.
 
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annual health check blood-borne viruses sexual health STIs syphilis

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