Status:
Active
Health advisory:
210329
Date Issued:
29 Mar 2021 - Update to Advisory issued 22 July 2020
Issued by:
Adjunct Clinical Professor Brett Sutton, Chief Health Officer, Victoria
Issued to:
Health professionals and the community

Key messages

  • Victoria continues to experience an upsurge in syphilis.
  • Untreated or inadequately treated syphilis in a pregnant woman can result in congenital syphilis in the baby, a serious public health problem, that has re-emerged in Victoria, with ten cases reported since 2017.
  • Congenital syphilis can result in miscarriage, stillbirth, prematurity, low birth weight and a variety of other possible adverse consequences in an affected baby.
  • All pregnant women should be tested for syphilis during routine antenatal testing in the first trimester and these tests should be repeated in any pregnant woman presenting at any stage of pregnancy with signs and symptoms suggestive of a sexually transmitted disease (such as a genital lesion).
  • Syphilis testing should be repeated at 28 to 32 weeks of pregnancy, and at delivery, in pregnant women who may be at high risk of sexually transmitted diseases.
  • Syphilis can be easily treated with long acting (benzathine) penicillin, and advice on the appropriate treatment and follow up of a pregnant woman diagnosed with syphilis can be obtained from any Infectious Diseases Clinic or the Melbourne Sexual Health Centre. 
  • Preventing congenital syphilis requires active intervention and follow-up on the part of treating clinicians. Babies born to mothers who had been diagnosed with syphilis during pregnancy require specialist follow-up.

What is the issue?

Congenital syphilis caused by mother-to-child transmission of infection is an entirely preventable public health problem which has re-emerged in Victoria with ten cases reported since 2017. 

This has occurred on a background of an increase in notified cases of infectious syphilis in both men and women over the past six years, with the majority of notified cases in women of reproductive age with the potential for the condition to occur in pregnancy. The reported cases of infectious syphilis increased from 635 cases in 2014 to 1,676 cases in 2019. There were 1,444 cases in 2020, with the small reduction in notified cases associated with reduced testing during this time, as a result of the COVID pandemic.

Syphilis occurring in pregnancy requires prompt treatment and follow-up to prevent serious adverse consequences in the baby.  

Active screening of all pregnant women, early case detection, timely and appropriate treatment and adequate follow up of infected women, their babies and their sexual partners is required to eliminate congenital syphilis.

Who is at risk?

Women who are at risk of having a pregnancy complicated by syphilis include:

  • Those who have more than one sexual partner.
  • Female partners of men who have sex with men (gay or bisexual).
  • Sex workers who do not get regularly tested for sexually transmissible diseases.
  • People who use or inject drugs.
  • Women of Aboriginal and Torres Strait Islander origin.
  • Those with overseas sexual contacts, especially from countries with high prevalence rates of sexually transmissible diseases.
  • Those women presenting with any other sexually transmissible infection during pregnancy.

While all women should be tested for syphilis during routine antenatal screening in the first trimester, further tests for syphilis and other sexually transmissible diseases should be undertaken at 28 to 32 weeks of pregnancy, and at delivery for women in any of the above risk groups as well as for all women in communities experiencing syphilis outbreaks.

Symptoms and transmission

Congenital syphilis occurs as a result of transplacental transmission during pregnancy or from mother to baby during birth. A woman with syphilis can remain infectious during the primary, secondary and early latent periods of the clinical course, usually for up to two years from infection if left untreated. 

Congenital syphilis can result in stillbirth, prematurity, low birth weight or neonatal death. Babies born with congenital syphilis can appear normal at birth but develop a range of clinical manifestations by two months of age. These include problems with blood, brain, bones, organ enlargement, and muco-cutaneous lesions. 

Late manifestations of congenital syphilis can appear from two years after birth and include central nervous system abnormalities, eye and hearing problems, and bone or teeth abnormalities.

Recommendations

Testing and Screening

  • Test all pregnant women for syphilis during routine antenatal screening in the first trimester of pregnancy, or if presenting for the first time in late pregnancy without previous antenatal care.
  • Repeat syphilis tests at 28 to 32 weeks of pregnancy, and at delivery, in all women at high risk of sexually transmissible infections, and in all women presenting at any stage of pregnancy with the clinical signs of any other sexually transmissible infection. Repeat syphilis tests in all women in communities experiencing syphilis outbreaks. The Department of Heath will issue alerts to clinicians in areas where a syphilis outbreak occurs.  
  • Notify all cases of syphilis to the Department of Health and |Human Services.

Treatment of cases and contacts

  • Any pregnant woman diagnosed with syphilis requires prompt and appropriate treatment with long acting (benzathine) penicillin. Short acting formulations such as benzylpenicillin are ineffective and should not be used.
  • Ensure the patient is not lost to follow up. Advice on appropriate management in pregnancy is available from Infectious Diseases Clinics, or from the Melbourne Sexual Health Centre doctors’ information line (1800 009 903).
  • Sexual contacts of women diagnosed with syphilis during pregnancy should be tested and treated without waiting for test results to prevent re-infection during the pregnancy.
  • All babies born to mothers diagnosed with syphilis in pregnancy will require follow up and testing overseen by a specialist paediatric clinic such as those at the Royal Children’s Hospital or the Monash Medical Centre. 
  • All cases of syphilis in pregnancy require close cooperation between GP, laboratory and specialist clinic to ensure mothers and their babies are treated appropriately and not lost to follow-up The Department’s Partner Notification Officers (see below), can assist with cases lost to follow up.

Partner notification

  • The Partner Notification Officers from the Department of Health and Human Services are available to assist in contacting the sexual partners of any patient diagnosed with a sexually transmissible infection. This is a confidential service and they can be reached on 9096 3367 or by email contact.tracers@dhhs.vic.gov.au.
  • Partner notification tools are available to contact partners anonymously at Let Them Know  and The Drama Down Under. 

Patient education 

  • Advise all women diagnosed with syphilis in pregnancy of the importance of adequate treatment and appropriate follow up of mother and baby to prevent adverse health consequences in the baby.
  • Advise all pregnant women at high risk for sexually transmissible infections of the importance of being tested for syphilis in both early and late pregnancy and of the importance of safe sex in trying to prevent syphilis in pregnancy.

More information

Syphilis - Fact sheet for clinicians 
Congenital Syphilis – Important information for health professionals 
Congenial syphilis – Information for women and their partners 
Australian STI Management Guidelines for use in Primary Care 
Better Health Channel - Syphilis

Contacts

Communicable Diseases Prevention and Control Unit: Telephone 1300 651 160, Fax 9096 9174, email infectious.diseases@dhhs.vic.gov.au.