Public health alert: syphilis outbreak in Central Queensland

In Central Queensland, News by Jasmin Midgley

Outbreak of infectious syphilis in Central Queensland
Attn: All clinicians in Central Queensland

There has been an increase in cases of infectious syphilis in Central Queensland Hospital and Health Service area where it’s considered to be an outbreak.

The recent syphilis cases in the region appears to be mainly in two relatively distinct groups: heterosexual Aboriginal and Torres Strait Islander people, and non-Indigenous gay men and other men who have sex with men.

Patient Management Recommendations:

• Offer sexually transmitted infection (STI) testing, including for syphilis and HIV, to all young people, especially Aboriginal and/or Torres Strait Islander people and those who have travelled aged 15-40 anytime they attend health services.

• Test all pregnant women for syphilis at first presentation. New Queensland Syphilis in Pregnancy Guidelines are available here.

• Aboriginal and/or Torres Strait Islander women should also be tested at 20 weeks, 28 weeks, 34-36 weeks gestation and delivery. All women who have had syphilis treated during the pregnancy and/or limited antenatal care should be tested for syphilis at delivery.

• No newborn should leave hospital until their mother’s syphilis status is known or has been requested.

• Test all people diagnosed with another STI for syphilis and HIV

• For any genital ulcers, treat and test for syphilis immediately. This includes a swab of ulcer and blood test. Do not wait for a positive test result.

• Contact trace for everyone diagnosed with infectious syphilis, so that all their sexual partners can be tested and treated. Do not wait for a contact’s test result before treating contacts.

• Encourage condom use.

Understanding syphilis:

• Syphilis is highly infectious in the first two years.
• Women who have not been treated can transmit to their unborn baby for up to eight years, resulting in congenital syphilis.
• Syphilis increases the risk of HIV transmission.
• Infectious syphilis can present with or without symptoms.
• Primary syphilis – may include one or more painful or painless ulcer/s (chancres), usually in the genital area. These spontaneously resolve in 3-6 weeks.
• Secondary syphilis – may include condylomata lata (raised flat-topped wart-like lesions), rash –esp. on the body, palms and soles of feet, patchy hair loss, lymphadenopathy, fever and flu-like illness.

Treatment of infectious syphilis:

• Benzathine Penicillin 1.8g IMI stat, given as two doses of 900mg by deep IMI.
• Refer Primary Clinical Care Manual or the Queensland Health Communicable Disease Control Guidelines.

Further information and assistance with contact tracing:

• Queensland Syphilis Surveillance Service (‘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 6989 or
• Blood Borne Virus & Sexual Health Service – 92 Bolsover Street (07) 4932 5440