Victoria health officials are reporting that syphilis infections in 2018 reached a record high and congenital syphilis has re-emerged in the southeastern state.
A total of 1,372 cases of infectious syphilis were notified in Victoria, compared to 1,351 cases in 2017 and 1,134 cases in 2016. The majority of notified cases continue to occur in males with 73 per cent of males reporting male sexual partners as the source of infection. Thirty per cent of the cases among MSM were HIV positive and of these, 57 per cent were reinfections.
There has been an increase of notified syphilis cases among women over the last few years. In 2018, 163 cases were notified (representing 12 per cent of total cases). There were 152 cases in 2017 (11 per cent of total cases) and 101 in 2016 (9 per cent of total cases). The increase of syphilis in women of reproductive age is of particular public health concern as syphilis during pregnancy can cause congenital syphilis which may result in serious birth defects and stillbirth.
For the first time since 2004, congenital syphilis has re-emerged in Victoria, with two cases notified in 2017 and two cases in 2018. Two cases have resulted in fetal death. Women may be unaware of their risk of syphilis.
Screening at-risk groups, including antenatal screening, and adequate timely treatment of cases and sexual partners are crucial for the prevention of syphilis infections.
Health officials recommend:
Test all patients presenting with symptoms consistent with syphilis infection (i.e. any genital skin or mucous membrane lesion or an unexplained rash).
- Screen all pregnant women for syphilis, other STIs and BBVs at the first antenatal visit.
- Repeat screening for pregnant women with risk factors at 28-32 weeks and at delivery. Risk factors include: women with multiple sexual partners, female sexual partners of MSM, women who inject drugs, women of Aboriginal and Torres Strait Islander origin, women with overseas sexual contacts where syphilis is more prevalent. Sex workers may also be at greater risk if they are not having regular STI testing.
- Screen heterosexual men and women with risk factors: multiple sexual partners, travellers returning from countries where syphilis is more prevalent and people who inject drugs, sex workers.
- Screen all other groups at risk:
- Screen all MSM for syphilis at least annually with blood tests for syphilis; Screen MSM more often (e.g. every 3 months) if one or more of the following applies: any unprotected anal sex, more than 10 sexual partners in the last 6 months, participation in group sex, use of recreational drugs during sex.
- HIV positive MSM should have a syphilis test every time (an opt-out strategy) they have blood tests for routine HIV monitoring. HIV positive MSM and HIV positive bisexual men should also have regular screening for other STIs including gonorrhoea and blood borne viruses (BBVs).
- Screen bisexual men for syphilis and other STIs.
- Screen all people on PrEP in three monthly intervals and counsel them on combination prevention methods.
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