Congenital Syphilis in Victoria

What is the issue?

Cases of congenital syphilis represent a serious and preventable public health problem which has re-emerged in Victoria since 2017 with a total of 14 cases of congenital syphilis, including 6 stillbirths. Prior to 2017, only 2 congenital cases were notified in the preceding 25 years.

This has occurred along with an increase in infectious syphilis among women of reproductive age (15-49 years of age) over the past six years, with the highest number of cases notified in 2021. 95% of total female cases notified are of reproductive age and have doubled from 95 cases in 2016, to 184 cases in 2021.

Syphilis occurring in pregnancy requires prompt treatment and follow-up to prevent serious adverse consequences in the baby.

Eliminating congenital syphilis requires active screening of all pregnant women, early case detection, timely and appropriate treatment, and adequate follow up of infected women, their babies, and their sexual partners.

Who is at risk?

Women who may be at increased risk of syphilis in pregnancy include:

• Those who have more than one sexual partner.
• Female partners of men who have sex with men.
• Those who use or inject drugs.
• Aboriginal and Torres Strait Islander woman.
• Those with overseas sexual contacts, especially from countries with high rates of sexually transmissible infections.
• Those presenting with any other sexually transmissible infections during pregnancy.

Symptoms and transmission

Congenital syphilis occurs as a result of transplacental transmission during pregnancy or from mother to baby during birth. A woman with syphilis can remain infectious during the primary, secondary and early latent periods of the clinical course, usually for up to two years from the time of infection acquisition if left untreated.

Congenital syphilis can result in stillbirth, prematurity, low birth weight or neonatal death. Babies born with congenital syphilis can appear normal at birth but develop a wide range of clinical manifestations by two months of age.

Late manifestations of congenital syphilis can appear from two years after birth and include central nervous system abnormalities, eye and hearing problems, and bone or teeth abnormalities.

Recommendations

Testing and screening

• Test all pregnant women for syphilis during routine antenatal screening in the first trimester of pregnancy, or if presenting for the first time in late pregnancy without previous antenatal care.
• Repeat syphilis testing at 28 to 32 weeks of pregnancy, and at delivery, in all women at risk of sexually transmissible infections, and in all women presenting with signs or symptoms of any other sexually transmissible infection.
• Repeat syphilis tests in all women in communities experiencing syphilis outbreaks. The Department of Heath will issue alerts to clinicians in areas where a syphilis outbreak occurs.
• Actively follow up pregnant women who do not attend for testing.
• Notify all cases of syphilis to the Department of Health

Treatment of cases and contacts

• Any pregnant woman diagnosed with syphilis requires prompt and appropriate treatment with long acting (benzathine) penicillin. Short acting formulations such as benzylpenicillin are ineffective and should not be used.
• Ensure the patient is not lost to follow up. Advice on appropriate management in pregnancy is available from Infectious Diseases physicians, or from the Melbourne Sexual Health Centre doctors’ information line (1800 009 903).
• Sexual contacts of women diagnosed with syphilis during pregnancy should be tested and treated without waiting for test results, to prevent re-infection during the pregnancy.
• All babies born to mothers diagnosed with syphilis in pregnancy will require follow up and testing overseen by a specialist paediatric clinic such as those at the Royal Children’s Hospital or the Monash Children’s hospital.
• All cases of syphilis in pregnancy require close cooperation between GPs, laboratories, and specialist clinics to ensure women and their babies are treated appropriately and not lost to follow-up. The Department’s Partner Notification Officers (see below) can assist with cases lost to follow up.

Partner notification

• The Partner Notification Officers from the Department of Health are available to assist in contacting the sexual partners of any patient diagnosed with a sexually transmissible infection. This is a confidential service, and they can be reached on (03) 9096 3367 or by email contact.tracers@dhhs.vic.gov.au
• Partner notification tools are available to contact partners anonymously at Let Them Know and The Drama Down Under.

Partner education

• Advise all women diagnosed with syphilis in pregnancy of the importance of adequate treatment and appropriate follow up of mother and baby to prevent adverse health consequences in the baby.
• Advise all pregnant women at risk of sexually transmissible infections of the importance of being tested for syphilis in both early and late pregnancy and of the importance of safer sex in trying to prevent syphilis in pregnancy.
• Advise all people diagnosed with syphilis on the importance partner notification, testing, and treatment to prevent further infections. Offer active support with partner notification.