The outbreak of syphilis in Aboriginal and/or Torres Strait Islander young people continues in North Queensland. There have also been increased syphilis notifications in men who have sex with men, notably in the Cairns and Hinterland HHS area.
Recently there have been several cases of infectious syphilis diagnosed within Rockhampton HHS area (e.g. Central Highlands). With increased mobility and people travelling to the affected outbreak areas, we would like to remind clinicians of the need to test at-risk groups.
At risk groups: Most cases of syphilis in North Queensland are in Aboriginal and/or Torres Strait Islander people aged 15 – 40 years. Gay men and men who have male sexual partners are also at risk.
Consequences: Syphilis is highly infectious in the first two years. Untreated pregnant women can transmit to their unborn babies for up to 8 years, causing serious outcomes from congenital syphilis. Syphilis increases the risk of HIV transmission.
Offer opportunistic syphilis testing to all people in at risk groups, anytime they attend. Rapid Testing for syphilis is also available at the Blood Borne Virus & Sexual Health Service located at 92 Bolsover Street, Rockhampton.
Key points:
- Offer STI and syphilis testing to all young people, especially Aboriginal and Torres Strait Islander people aged 15 – 40
- Test women for syphilis immediately on confirmation of pregnancy
- Test pregnant women at increased risk, including Aboriginal and Torres Strait Islander women, at 28 weeks and at 34 – 36 weeks gestation. Also test for syphilis at delivery if she had syphilis treated during the pregnancy and/or limited antenatal care
- Test for syphilis and HIV in all people diagnosed with another STI
- For any genital ulcers, treat and test for syphilis immediately. Do not wait for the positive test result.
- Trace contacts for all people diagnosed with infectious syphilis and treat and test all sexual partners of people who have infectious syphilis (contact trace partners from the previous 3 months + duration of symptoms). Do not wait for a positive test result.
- Encourage condom use.
Symptoms: ‘infectious’ syphilis is infection in the first two years after acquisition. It can be without symptoms (early latent syphilis) or with symptoms (primary or secondary syphilis). In primary syphilis these may include one or more chancres (ulcers), usually in the genital area. These may be painful or painless and spontaneously resolve in 3 – 6 weeks. Symptoms of secondary syphilis may include condylomata lata (raised flat-topped lesions), rash – especially on the body, palms and soles of feet, patchy hair loss, lymphadenopathy, fever and flu-like illness.
Treatment of infectious syphilis:
Syphilis proven to be <2 years duration (Including primary and secondary syphilis): Benzathine Penicillin 1.8gm IMI stat, given as two doses of 900mg by deep IMI.
Syphilis of >2 years or unknown duration: Benzathine Penicillin 1.8gm IMI (given as two doses of 900mg by deep iMi) once a week for three weeks.
Further information, support and assistance with contact tracing:
Syphilis Register on 1800 032 238 or email North-Qld-Syphilis-Surveillance-Centre@health.qld.gov.au Rockhampton Community and Public Health Service – (07) 4920 6900 or Blood Borne Virus & Sexual Health Service – 92 Bolsover Street (07) 4932 5440.
Download the Multijurisdictional Syphilis Outbreak Surveillance Report for October 2018.
Yours Sincerely,
Dr Gulam Khandaker
Director & Public Health Physician
Central QLD Public Health Unit
Candise Bradshaw
Nurse Unit Manager
Blood Borne Virus & Sexual Health Service