What is the issue?
Infectious syphilis is defined as infection less than two years duration and includes primary, secondary and early latent clinical presentations.
A total of 654 cases of infectious syphilis were notified in Victoria in 2013, the highest annual number since the Department of Health & Human Services electronic records began in 1991. In 2014, 625 cases were notified, the second highest annual number. In the first quarter of 2015 there were 224 cases, a 75% increase compared with the same period in 2014. The large majority of notified cases are in MSM. Around half of the cases are in HIV positive MSM, and of these, a significant proportion are reinfections.
Syphilis is highly infectious, and can be transmitted by unprotected vaginal, anal and oral sex and skin to skin contact during sex. Syphilis is often asymptomatic or presents atypically without the chancre characteristic of primary syphilis or the rash of secondary syphilis. Syphilis infection is of particular public health importance because it increases both susceptibility to acquiring HIV infection and transmissibility of HIV infection.
Screening of groups at risk is essential for syphilis control, along with partner notification and prevention education.
Clinicians play a vital role in syphilis control and prevention through early detection and treatment of cases and their contacts.
What is the action required?
- Screen all MSM for syphilis at least annually. Screen MSM more often (e.g. every 3 months) if one or more of the following risk behaviours apply: any unprotected anal sex, more than 10 sexual partners in the last 6 months, participate in group sex, use recreational drugs during sex.
- Screen all HIV positive MSM for syphilis as part of routine HIV monitoring (e.g. implement an opt-out strategy).
Treatment of cases and contacts
- Treat all cases of infectious syphilis in accordance with the current guidelines.
- Treat all sexual contacts of syphilis cases without waiting for serological results if their exposure was in the last 90 days. Individuals exposed to syphilis should be given a single dose of intramuscular benzathine penicillin 1.8 g (2.4mU). Doxycycline 100mg twice daily for 14 days can be used in individuals who are allergic to penicillin. Immediate treatment of contacts prevents re-infection of the index case and further transmission.
- Ensure that all possible attempts are made to contact sexual partners of MSM with syphilis at the time of diagnosis.
- Innovative partner notification tools are now available to contact partners anonymously via SMS or email. You can undertake partner notification at the time of consultation or strongly encourage your patients to contact their partners themselves.