Syphilis outbreak in Queensland

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 during pregnancy (congenital syphilis). 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 during pregnancy is high for untreated infections. 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

Since January 2011, there has been an ongoing outbreak of infectious syphilis across northern Australia. The outbreak was first declared in North West Queensland, followed by the Northern Territory in July 2013, Western Australia in June 2014, and South Australia in November 2016. A Multijurisdictional Syphilis Outbreak (MJSO) Working Group was formed by the Communicable Diseases Network of Australia in 2015 to enable affected jurisdictions to coordinate the public health response. The MJSO has predominantly affected First Nations peoples residing in remote and rural areas.

In recent years, the epidemiology of syphilis has changed. Increased notifications of infectious syphilis have been observed in urban and major cities across Australia, including South East Queensland. This has corresponded with an increase in notifications among women of reproductive age, syphilis in pregnancy, and continued notifications of congenital syphilis. First Nations populations and gay, bisexual, and other men who have sex with men (GBMSM) continue to be disproportionally affected. Further information on the evolving epidemiology of syphilis in Queensland can be found under syphilis surveillance and reporting.

Syphilis is a national priority

In 2025, Australia’s Chief Medical Officer, Professor Michael Kidd AO, declared syphilis a Communicable Disease Incident of National Significance, in recognition that syphilis is a national health priority. Syphilis is preventable and all health providers have a role to play in reducing the health impacts and transmission.

Clinical management

Timely and adequate testing and treatment for syphilis (including during pregnancy) and contact tracing of sexual partners is paramount for reducing notifications, risk of infection and burden of disease.

For all pregnancies, the Queensland Clinical Guideline: Syphilis and pregnancy (PDF 542 kB) recommends testing for syphilis during routine antenatal screening; before 10 weeks (at confirmation of pregnancy or first antenatal visit), at 26-28 weeks, and again at 36 weeks gestation. Patients at risk of inadequate antenatal care are to be screened opportunistically. If syphilis status is unknown at birth, or if 36-week test was missed, then testing at birth should also occur.

Asymptomatic sexually transmissible infection (STI) testing is to occur for anyone that requests testing, has a new sexual partner, is living or travelling to areas of higher prevalence, has had a known exposure to any STI in the past 12 months, or are a part of, or are a partner to a priority population such as First Nations populations and GBMSM.

Clinicians are also encouraged to take a sexual history, discuss prevention and initiate STI testing for all sexually active patients, including syphilis serology, particularly if any ulcers around the mouth, anus or genitals, or rashes are present. Symptoms, if present, will vary across the stages of syphilis infection. More information on testing, symptomology and treatment can be found in the Australian STI Management Guidelines For Use In Primary Care.

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
• North Queensland

Syphilis surveillance and reporting

Syphilis is a notifiable sexually transmissible infection in Queensland under the Public Health Act 2005 and Public Health Regulation 2018 with all laboratory-diagnosed positive syphilis test results notified to the Notifiable Conditions System. Data on notifiable conditions in Queensland are reported weekly and publicly accessible.

Queensland Health releases detailed surveillance reports on bloodborne viruses and sexually transmissible infections, including syphilis, on the following webpage: Surveillance, reports and research for sexual health. The Syphilis in Queensland series of reports provide information on the temporal, geographic, and demographic trends of syphilis notifications in Queensland, with a focus on priority populations.

National syphilis monitoring reports are produced by the Australian Government Department of Health, Disability and Ageing. These include national syphilis surveillance quarterly reports and historical MJSO reports.

Information, guidelines and resources

• Syphilis fact sheet
• A guide to discussing syphilis testing - for healthcare professionals

Case report forms:

• North Queensland Syphilis Case Report Form (PDF 304 kB)
• South Queensland Syphilis Case Report Form (PDF 276 kB)

Testing and management tools and guidelines:

• STI/BBV Testing Tool for Asymptomatic People (PDF 676 kB)
• Queensland Clinical Guideline – Syphilis and pregnancy (PDF 542 kB)
• Australasian Society for HIV, Viral Hepatitis and Sexual Health Medicine (ASHM) Could it be Syphilis? Clinical indicator tool
• 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

Syphilis campaigns

• Stop syphilis is an ASHM campaign and resources page for raising awareness and reducing the prevalence of syphilis in Australia.
• Lady Peeps raises awareness among women about syphilis, particularly during pregnancy.
• Young, Deadly, Syphilis Free is a multi-strategy STI awareness-raising campaign, encouraging young Aboriginal and Torres Strait Islander people to get tested and treated.
• Let’s treat syphilis is a campaign developed by Queensland Positive People and Queensland Council for LGBTI Health to increase awareness GBMSM.
• Don’t fool around with syphilis is a national campaign with downloadable posters and fact sheets.

Training

• Syphilis Outbreak Training - this syphilis training website provides professional development for any health practitioners working in areas affected by a syphilis outbreak.
• Introduction to Syphilis Nursing - this online learning module is designed for nurses and midwives working with people at risk of STIs and BBVs.
• Syphilis Testing in Antenatal Settings: Train the Trainer - designed for antenatal care providers looking to become leaders about syphilis in their own workplace.