Enhanced screening for Syphilis for Aboriginal people in SA

There is a current outbreak of syphilis in Northern and Central Australia which began in 2011 and has now affected more than 1000 people in Queensland, Northern Territory and WA including deaths from congenital syphilis. Since the beginning of 2016, a small number of cases in SA have been linked to this outbreak. New cases have mostly occurred in younger people age 16-30 years. Staff should be aware of the increased possibility of syphilis in the area. The public health significance of syphilis lies in its impact on the developing foetus in utero as well as enhancing both the transmission and acquisition of HIV.

Clinical features
Transmission of syphilis is via sexual contact or vertical transmission from mother to child in utero. Syphilis is most infectious within the first 2 years of infection during the primary and second stages (early infection).
The genital lesion of primary syphilis (chancre) usually appears about 4 weeks after contact but it can be up to 3 months. The lesion is usually firm, round and painless and may go unnoticed. It is highly infectious at this stage. The sore lasts 3 to 6 weeks and heals regardless of whether or not treatment is given.
The secondary stage produces a rough, red rash typically on the palms of the hands and/or the soles of the feet. It can occur immediately or up to 6 months after the primary chancre has healed. Other secondary stage symptoms include mucous membrane lesions (mouth, vaginal or anal sores), fevers, lymphadenopathy, sore throat, patchy hair loss, headaches, weight loss, muscle aches and fatigue. The mucous membrane lesions of the secondary stage are also highly infectious. Symptoms in this stage will also resolve regardless of treatment. However, one third of those who are not treated will go on to develop tertiary syphilis after a period of 10-30 years characterised by potentially serious cardiac and neurological complications.
For syphilis in pregnancy, the risk of transmission is very high (70-100%) with untreated early syphilis (primary, secondary stages) with up to a third of pregnancies resulting in miscarriage or stillbirth.

Screening / diagnosis
Testing for syphilis (order ‘syphilis serology’) should be offered in the following circumstances:

  • Where there is clinical suspicion of syphilis as above;
  • Antenatal testing – in addition to testing at the first visit (10-12 weeks) this should be repeated at 28 weeks, 36 weeks, then also at delivery and at the 6 week post-natal check;
  • During routine STI screening in 16-30 year olds – particularly in those who are known to have a sexual network connection to the outbreak areas;
  • For anyone who is diagnosed with another STI such chlamydia, gonorrhoea or trichomonas (offer HIV testing as well);
  • Anyone aged 16-30 who is having blood taken for another reason – eg. during an adult health check (715 item) or who presents to the emergency department.

Management

  • Contact SA pathology if interpretation of results is required – to differentiate latent/late disease or old, treated infection from early infection
  • Immediate treatment with Penicillin for those where there is clinical suspicion or a positive test for early infection – see CARPA manual or discuss with sexual health/infectious disease physician
  • Immediate partner notification – SA Health Communicable Disease Control Branch will assist. How far back to trace depends on the stage and onset of symptoms.
  • Syphilis in pregnancy – discuss treatment immediately with an infectious disease physician


For further information contact Dr David Johnson, Public Health Medical Officer, Aboriginal Health Council of South Australia on 08 8273 7200 or email This email address is being protected from spambots. You need JavaScript enabled to view it..
 

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