New data published online paints a concerning picture of rising infectious syphilis cases among women of reproductive age in Australia (15-44 years old). This trend is accompanied by a subsequent increase in congenital syphilis, the transmission of syphilis from a pregnant parent to their child. Congenital syphilis is a preventable tragedy, easily avoided through timely testing and treatment of syphilis during pregnancy. Left untreated, congenital syphilis can lead to devastating outcomes in over 50% of cases, including miscarriage, stillbirth, neonatal death, and permanent disability.
A comprehensive review of all congenital syphilis cases in Australia between 2011 and 2021 revealed a heartbreaking reality: 25% of affected babies were stillborn. Furthermore, the study found that less than 40% of birthing parents of babies with congenital syphilis had been tested for syphilis during pregnancy, with almost half having no record of receiving any antenatal care.
While experts have been aware of the resurgence of syphilis in Australia for some time, this study provides the first analysis highlighting significant gaps in antenatal care, directly contributing to these tragic outcomes.
The rate of infectious syphilis in women aged 15-44 has surged dramatically over the past decade, increasing by over 500% between 2011 and 2021, from 141 cases in 2011 to 902 cases in 2021. This reflects a broader rise in syphilis cases among young people, a trend that began with men who have sex with men in metropolitan areas and young heterosexual individuals in remote Aboriginal and Torres Strait Islander communities.
Despite increased testing and public health campaigns initiated by health departments to combat the spread, syphilis cases have continued to climb, and the initial outbreaks have expanded across Australia. While substantial investment from federal, state, and territory governments has been directed towards enhancing syphilis detection and treatment, including community-based screening, media campaigns, health workforce education, and rapid point-of-care testing, cases of congenital syphilis have mirrored the international trend and steadily increased.
Between 2011 and 2019, Australia saw an average of four congenital syphilis cases per year. This number jumped to 17 cases in 2020, 15 in both 2021 and 2022, and 20 cases reported in 2023. While these numbers may seem small, without immediate action, this upward trend will lead to more deaths and permanent disabilities in babies with congenital syphilis, a preventable disease.
It’s imperative to prioritize efforts to reduce syphilis transmission, especially the impact of syphilis during pregnancy. Testing recommendations during pregnancy range from a single test at the initial antenatal appointment to five tests throughout the pregnancy, depending on the pregnant person’s risk factors and location, particularly in remote areas experiencing outbreaks. While state and territory health departments provide recommendations, these vary across Australia. However, efforts are underway to standardize guidelines.
Despite these efforts, many instances of no screening at all remain a major concern. The rise in infectious and congenital syphilis is likely linked to social determinants of health, including homelessness, unstable housing, poverty, domestic violence, mental illness, substance abuse, cultural barriers, language difficulties, racism, and discrimination within the healthcare system. The study found that Aboriginal and Torres Strait Islander women reported 35 times higher rates of syphilis than non-Indigenous women, likely due to the lasting impact of colonization, structural barriers, and limited access to healthcare.
To reverse the current alarming trend of increasing babies born with congenital syphilis, urgent action is required. This includes exploring accessible models of care for pregnant women across all healthcare settings, enhancing partner testing and treatment, and improving surveillance of syphilis testing during pregnancy.
Beyond medical check-ups, a holistic approach to care co-designed in partnership with affected communities is crucial, especially for Aboriginal and Torres Strait Islander women. This could involve greater access to Birthing on Country programs.
The World Health Organization (WHO) strongly recommends routine syphilis testing for partners to achieve the elimination of congenital syphilis. Additionally, robust monitoring of syphilis testing during pregnancy is essential. The WHO has set a global goal of eliminating congenital syphilis, aiming for 95% of pregnant people to be tested for syphilis during pregnancy. Currently, there is no way to assess Australia’s progress towards this goal.
Congenital syphilis is entirely preventable, and any pregnancy resulting in this outcome is a tragedy. The authors acknowledge the valuable contribution of Lorraine Anderson from Kimberley Aboriginal Medical Services, who provided guidance on the study that formed the basis of this article.
