Syphilis - a clinical resource

Content:

Part 1: Syphilis, what is the problem? 

Syphilis is an important global health problem which leads to serious complications including neurological problems and stillbirth. Despite availability of tests and treatment, rates of syphilis have climbed dramatically across Melbourne, affecting men, women and putting infants at risk. 

The number of syphilis infections in pregnant women across Australia has been increasing, resulting in preventable infant morbidity and mortality.
Untreated or inadequately treated syphilis in a pregnant woman can result in mother to child transmission of infection, causing congenital syphilis in the baby. This may result in miscarriage, stillbirth, prematurity, low birth weight or neonatal death.  

This is completely preventable! 

Syphilis can be easily detected on a blood test and treated with antibiotics that are readily available, and easy to administer.
Infection may be prevented in the infant if treated promptly. Delayed treatment, particularly in later pregnancy, may result in stillbirth or infant death.  

Ensure that you offer pregnant women syphilis screening in early pregnancy, and consider repeating syphilis serology at 28-32 weeks if any of the below criteria are met: 

• Women with more than one sexual partner. 
• Women whose male partners have sex with men. 
• Sex workers who do not get regularly tested for STIs. 
• Women of Aboriginal or Torres Strait Islander origin. 
• Women who inject drugs. 
• Women with overseas sexual contacts particularly from countries where STIs are common. 

Also be sure to test any woman who has not engaged in antenatal care, or presents for care late in their pregnancy.  

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Part 2: Syphilis presentation

Syphilis has distinct stages. Syphilis can appear with, or without symptoms. Symptoms depend on stage of infection. 

Primary syphilis can mimic herpes and can be detected early with a syphilis PCR swab. Secondary syphilis is the most infectious stage. Tertiary syphilis occurs years after initial infection and can affect numerous body systems. Neurosyphilis can occur at any stage of syphilis infection. 

You may need to seek advice from specialists to guide diagnosis and management. 

Resources: 

If you would like to see some images of primary and secondary syphilis lesions, take a look at the STI atlas 

Most syphilis cases are asymptomatic. All STI screening should include syphilis serology to avoid missed infections. 

Resources: 

See the ASHM STI screening guidelines 

Multilingual syphilis information sheets for patients 

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Part 3: Interpreting a syphilis result

A positive syphilis PCR confirms infectious syphilis. A syphilis history is essential to guide interpretation of serology. 

Use the ASHM tool to guide result interpretation and contact Melbourne Sexual Health Centre doctors line on 1800 009 903 if you require further support. 

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Part 4: Managing a Positive result

1. Interpret the result with support  (ASHM tool very useful for this).

2. Take a comprehensive syphilis history: Any prior tests? Any prior infection? Any prior treatment? Symptoms? 

3. Treat the patient: Treatment is IM Benzathine Penicillin.
   This is available in the doctors bag and should always be available in your service. Treatment regimen depends on the stage of syphilis infection.   

4. Management and treatment of sexual partners: Presumptively treat any sexual partners even if serology is negative, if they have had sex with the case in the last 6-8 weeks.  

5. Notify Department of Health  Electronic notification to the Department of Health (Victoria).

6. Monitor patient's RPR 3, 6, 12 months after treatment.

Treatment is IM Benzathine Penicillin. This is available in the doctor's bag and should always be available in your service.
Treatment regimen depends on the stage of syphilis infection.  See treatment guidelines

Management and treatment of sexual partners (Contact tracing)
An essential element of syphilis management is testing and treatment of sexual partners. Presumptively treat any sexual partners even if serology is negative, if they have had sex with the case in the last 6-8 weeks.  

To support contact tracing please use the resources below. 

Ongoing management
Monitor patient RPR 3,6,12 months after treatment 

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Resources:

Contact Tracing and Partner Management

Are you a clinician who would like further education about syphilis? 

See free resources below:  

Nurses: Introduction to syphilis for nurses 

Doctors:  General sexual health education for GPs | Infections in pregnancy CPD modules for GPs

Rural health professionals (CPD points): Facets of rural sexual health PCD course 

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