Syphilis outbreak in Queensland

On this page:

• Syphilis in Queensland
• Infectious syphilis outbreak
• Syphilis surveillance and reporting
• Clinical management and resources
• Queensland Syphilis Surveillance Service
• Syphilis campaigns
• Training

Syphilis is a curable multistage disease caused by bacteria of the species Treponema pallidum, subspecies pallidum, that can cause serious health problems if left untreated. Syphilis is usually transmitted during anal, oral or vaginal sex through skin-to-skin contact with an infected area or through vertical transmission from mother to child. There are 4 stages of syphilis infection: primary, secondary, latent and tertiary. Each of these stages presents with different signs and symptoms.

Infectious syphilis is a significant public health concern, particularly due to the risk of congenital syphilis. The risk of vertical transmission from mother to child is high for untreated infections, with the risk diminishing over the years but never disappearing. Syphilis can also increase the risk of HIV infection, as syphilitic genital ulcers provide a portal of entry for HIV acquisition and a focus for HIV transmission.

Syphilis in Queensland

As shown in the graph below, between 2001 and 2021 the rate of infectious syphilis notifications in Queensland increased six-fold from 3.1 to 20.2 cases per 100,000 people per year.

In Queensland, Aboriginal and Torres Strait Islander populations and men who have sex with men (MSM) continue to be disproportionally affected. However, since 2016 notifications among heterosexual women of reproductive age have also substantially increased.

Between 2001 and 2021, 41 cases of congenital syphilis were reported in Queensland, 29 of which were in Aboriginal and Torres Strait Island infants. Of these, 13 were associated with intrauterine foetal death/stillbirth or the babies died after birth.

Queensland infectious syphilis outbreak

There is an ongoing infectious syphilis outbreak affecting young Aboriginal and Torres Strait Islander people living in Queensland, the Northern Territory, South Australia, and Western Australia, particularly in rural and remote areas. Increased syphilis numbers were observed in the North West Hospital and Health Service in Queensland from January 2011, and an outbreak declared in the area in September 2011. From there, the outbreak has gradually spread across other states and territories with the entire northern and some parts of southern Australia now affected.

The Chief Medical Officer has issued a public health communique to health professionals advising of significant increases in notifications of women of reproductive age in major cities of Australia. This increase has been observed across Queensland’s southeast corner and poses an increased risk of congenital syphilis and adverse pregnancy outcomes.

Syphilis surveillance and reporting

Syphilis is a notifiable sexually transmissible infection (STI) in Queensland under the Public Health Act 2005 and Public Health Regulation 2018 with all laboratory-diagnosed positive syphilis test results being notified to the Notifiable Conditions System. Publicly available communicable diseases data is reported weekly at different levels across Queensland and is used to investigate local notification totals and trends.

Queensland Health produces reports describing notifications of syphilis in Queensland, focusing particularly on the demographic distribution and risk factors among infectious syphilis and congenital syphilis cases.

• Syphilis in Queensland 2021 report (PDF 9225 kB)
• Syphilis in Queensland 2019 report (PDF 639 kB)
• Syphilis in Queensland 2010–2015 (PDF 838 kB)

The Multijurisdictional Syphilis Outbreak Working Group (no longer active), formed by the Communicable Diseases Network of Australia in April 2015, also produced regular surveillance reports summarising national epidemiological data from the outbreak for the period 2016–2020.

Clinical management and resources

Timely and adequate testing and treatment for syphilis (including during pregnancy) and contact tracing of sexual partners are paramount for reducing notifications, risk of infection and burden of disease. Clinicians are encouraged to take a sexual history from all their patients and consider that infectious syphilis is possible in any of their sexually active patients.

Information sheets:

• Syphilis fact sheet
• Sexual health conversation starter sheet for GPs

Case report forms:

• North Queensland Syphilis Case Report Form (PDF 249 kB)
• South Queensland Syphilis Case Report Form (PDF 224 kB)

Testing and management tools and guidelines:

• STI/BBV Testing Tool for Asymptomatic People (PDF 639 kB)
• Queensland Clinical Guideline – Syphilis in Pregnancy (PDF 558 kB)
• ASHM syphilis decision-making tool
• Australian STI Management Guidelines
• National case definitions for infectious syphilis, syphilis unspecified and congenital syphilis
• Series of National Guidelines (SoNGs) - Syphilis

Queensland Syphilis Surveillance Service

The Queensland Syphilis Surveillance Service (QSSS) (North and South Queensland teams) reviews all notified syphilis cases. They provide the treating clinician with information about a patient’s history of syphilis testing and treatment to support the accurate staging of infection and clinical management. The service also plays a key role in enhanced surveillance data collection, and education on syphilis, and may assist with contact tracing.

Phone: 1800 032 238
Email:

• South Queensland Qld-syphilis-surveillance-service@health.qld.gov.au
• North Queensland North-qld-syphilis-surveillance-centre@health.qld.gov.au

Syphilis campaigns

• Lady Peeps raises awareness among women about syphilis, particularly during pregnancy. The campaign encourages all women who are sexually active to take control of their sexual health and seek regular STI tests that include syphilis.
• Young, Deadly, Syphilis Free campaign is a multi-strategy STI awareness-raising campaign developed in response to the ongoing syphilis outbreak affecting Aboriginal and Torres Strait Islander communities, with a central focus on encouraging young people aged 15 to 34 to get tested and treated.
• Let’s treat syphilis is a campaign developed by Queensland Positive People and Queensland Council for LGBTI Health aimed at increasing awareness about the rapidly rising rates of syphilis in Queensland among MSM.
• Don’t fool around with syphilis is a national campaign launched to raise awareness of syphilis and the current multijurisdictional outbreak.
• WA syphilis outbreak awareness campaign was developed in response to the outbreak of syphilis in the Perth metropolitan area and aims to raise awareness of syphilis in women and encourage STI testing of females aged 16–40 years.
• Respect Me + You, Is Your Syphilis Check Up Due is a collaboration between the Aboriginal Health Council of South Australia and SHINE SA that promotes the message of staying connected and getting tested for syphilis.

Training

• Antenatal Sexual Health Kit (ASK) training for antenatal clinicians—understanding syphilis and congenital syphilis risk, undertaking sexual health assessments and initiating contact tracing in a maternity context.
• Syphilis Outbreak Training—this syphilis training website provides integral professional development for any health practitioners working in areas affected by the syphilis outbreak including doctors, nurses, midwives, and Aboriginal and Torres Strait Islander Health Workers.
• Introduction to Syphilis Nursing—this online learning module is designed to provide nurses with knowledge of priority populations for screening and testing, appropriate testing, interpretation of serology and contact tracing to reduce syphilis infections in Australia.