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Testing for syphilis at every opportunity

This STI Awareness Month, NSW Health looks at recent outbreaks of syphilis around the country, particularly within Aboriginal and Torres Strait Islander communities, and implores GPs to remain alert in a bid to stop the spread. 

 

Imagine this: Jane is a 22-year-old Aboriginal woman from a regional New South Wales (NSW) town who presents to you requesting the contraceptive pill. She’s been married to her husband for one year.

Would you offer a syphilis test?

Since 2011, an ongoing outbreak of syphilis has primarily spread amongst Aboriginal and Torres Strait Islander people aged 15 to 30 across mainly rural and remote areas of Queensland, the Northern Territory, Western Australia and South Australia, and most recently metropolitan Adelaide.

While cases related to the outbreak have not yet reached NSW Aboriginal communities, and syphilis in NSW continues to be most commonly found in urban men who have sex with men, it is important to remain alert. More syphilis tests, more often can help detect and stop a local syphilis outbreak in NSW.

So, who should you test for syphilis?

Syphilis is a sexually transmissible infection (STI), transmitted via vaginal, anal and oral sex. Sexually active people under 35, people with symptoms, people diagnosed with any other STI and, of course, their partners should be tested.

In this case, Jane should be offered a syphilis test. She is under 35, sexually active, and Aboriginal. She is found to have early latent syphilis and both she and her partner are successfully treated.

Two years after her first visit, Jane returns for antenatal care.

What syphilis testing would you offer Jane during her pregnancy?

Syphilis crosses the placenta at all stages of pregnancy and early syphilis is fatal to a foetus in almost 100% of cases. It is therefore vital for syphilis to be detected early and treated urgently in pregnancy.

NSW Health has identified four key opportunities for GPs to offer syphilis testing as part of routine consultations:

  1. Pregnant women whose child will be Aboriginal (i.e. Aboriginal women or non-Aboriginal women with Aboriginal partner) should be offered two tests during pregnancy: once at presentation and once at 28 weeks.
  2. All routine sexual health check-ups, and especially in patients who are diagnosed with any other STI.
  3. If collecting blood for other tests, include a syphilis test. For example, include syphilis testing into the annual Aboriginal Health Checks (MBS 715) as a routine.
  4. Contact and offer testing to partners of people diagnosed with syphilis. Partner notification isn’t necessarily complex – it starts with a simple conversation with your patient.

Jane needs to be tested today – at her first visit – and again at her 28 week visit.

As Jane has been previously diagnosed and treated for syphilis, she remains syphilis antibody reactive, but her rapid plasma reagin (RPR) test results remain non-reactive. Jane is syphilis free and can look forward to a healthy pregnancy and a new baby.

See the STI/HIV Testing Tool for testing advice and the NSW STI Programs Unit for sexual health resources and tools for clinicians and patients.

Further information & support

In NSW - contact the NSW Sexual Health Infolink or your local sexual health clinic.

Read the recent NSW Health syphilis alert here.

Outside NSW - contact your local sexual health clinic or specialist support service and/or local health authority.

 

Click here to access ThinkGP's suite of free, online sexual health education.

Breonny Robson

 

       Proudly sponsored by:                            
       NSW STI Programs Unit, part of the NSW Ministry of Health.