Is syphilis still around today?

Syphilis “The Great Pretender”: Just Pretending to be Obsolete? 

The term ‘syphilis’ often conjures up images of afflicted artists and writers in Golden Age Paris, Columbus returning from the “New World”, or Al Capone’s release from Alcatraz due to advanced disease. Whilst once referred to as the “infinite malady” by Shakespeare, syphilis has been curable since the discovery of penicillin. Closer to home, we’ve also played a huge role in syphilis research and management. Did you know that the world’s first scientific collection of community-based syphilis data was done right here in Melbourne, in 1910¹?  

However, syphilis is anything but a disease of the past. It is currently experiencing a massive surge in many Australian communities. Australian Government data indicates that, in 2022, rates of syphilis were double that of recorded cases in 2015.² Let’s take a closer look at what syphilis looks like, and how it can affect your health.  

What is syphilis?  

Syphilis is caused by a bacterium called Treponema pallidum.  

Syphilis infections have several hallmark features, including an initial painless sore (or ‘chancre’) which develops soon after exposure, and then a generalised body rash which occurs several weeks to months later. However, not everybody experiences these ‘classic’ symptoms, and syphilis has been nicknamed “the great pretender” because it can mimic many other diseases, making it hard to identify.  

Eventually, if untreated, syphilis infection becomes largely silent for a variable period of time – sometimes for up to a decade, before long-term nervous system, psychological and cardiac symptoms may declare themselves. Because of syphilis’ vague early symptoms followed by a long asymptomatic period, many people with this particular sexually transmitted infection (STI) are not aware they have been infected.  

However, it can be very dangerous for long-term health, and is a known cause of congenital disease for babies born by infected mothers. As such, syphilis awareness and testing is becoming a priority in Australia to manage our current outbreak and continue to keep our communities healthy. 

Who is at risk? 

Everyone who is sexually active is at risk of developing syphilis. However, certain groups are known to be higher risk of contracting the disease, including women of reproductive age, Aboriginal and Torres Strait Islander people (especially those in regional and remote areas with known outbreaks), and men who have sex with men (MSM).² However, increasing rates of syphilis are also being discovered in the heterosexual community; in a study comparing rates of positive syphilis tests in people being screened at sexual health clinics in major Australian cities, 3 in 1000 tests for women were positive in 2019 (compared to 1.8 per 1000 tests in 2011), and 7.6 in 1000 tests for heterosexual men were positive in 2019 (from 6.1 per 1000 in 2011).³ Whilst these numbers seem only small, the Melbourne Sexual Health Centre has seen a 220% increase in syphilis cases amongst women over the past several years, according to The Age newspaper.⁴ Furthermore, as syphilis screening in the straight community is not as commonplace as that amongst the MSM community or for those involved in sex work, these numbers are likely under-representing the presence of syphilis in heterosexual networks. 

How can I be screened for syphilis? 

Luckily, syphilis screening is very straightforward and highly accessible. All it involves is a blood test, and this can be sought from your local GP or via a sexual health centre. Whilst testing for chlamydia and gonorrhoea can be done via urine or swab test, which is somewhat less invasive, syphilis testing does require a blood test, but this is also a good opportunity to screen for blood-borne viruses (BBVs) (given syphilis is known to increase the risk of acquiring HIV in high-risk populations,⁵ and many BBVs can infect people without symptoms). If you have a lesion on your genitals, anus, mouth or anywhere else that seems suspicious, this can also be swabbed by your doctor. 

What does treatment involve? 

Syphilis can be cured with penicillin, but the length of treatment depends heavily on how long a patient has had syphilis. If the duration of infection is less than two years, a once-off treatment of intramuscular penicillin is sufficient. If the infection has persisted for over two years, or the length of infection is unknown, it is safer to treat with weekly injections for three weeks to ensure clearance.⁶ Having regular screening for syphilis with general STI screens (recommended every 6-12 months if sexually active, or more frequently if you have new or multiple partners) can help guide your doctor about how long you may have had syphilis. 

Any case of syphilis requires notification to the Department of Health, and ‘contact tracing’ (the process of contacting recent sexual partners to notify them they are at-risk) is performed so they can also be tested and treated. Anyone with syphilis must abstain from sexual activity for at least 7 days after treatment, or until all antibiotics are completed. Given the potential for re-infection, avoid sexual contact with partners from up to the past 12 months until they have been treated as necessary.⁵ 

How can I protect myself? 

The only way to protect yourself from syphilis is through the consistent use of condoms for all types of sex (or dental dams if performing oral sex). Regular screening is useful to identify and treat syphilis as soon as possible if you do come into contact with it. 

Can syphilis affect my pregnancy? 

Syphilis screening is a routine test in early pregnancy, most commonly done by your GP when you are diagnosed as pregnant. However, it is possible to contract syphilis throughout pregnancy, so depending on your level of risk your pregnancy care team will decide if you need additional screening (which can be done at 28-32 weeks, at delivery, and at any other occasion if you are deemed at-risk or present with symptoms). Babies born to mothers with syphilis infection (even if appropriately-treated during pregnancy) require specialist follow-up.⁷ 

‘Congenital syphilis’ (a condition seen in babies who are infected with syphilis whilst in the womb) can result in poor pregnancy outcomes such as organ damage or physical deformities for the baby, or potentially miscarriage or stillbirth. Since 2017, Victoria has seen 14 cases of congenital syphilis, including six cases of stillbirth, and this is a major public health emergency.⁷ To be vigilant about this important issue, syphilis screening across Australia is being stepped up in order to keep mums, babies and everyone safe. 

References 

1. Temple-Smith, M 2019, ‘The birth of syphilis surveillance in Melbourne’, The Conversation, viewed 5 April 2024, https://www.themandarin.com.au/106816-the-birth-of-syphilis-surveillance-in-melbourne/  
2. Australian Government Department of Health and Aged Care 2024, National response to syphilis, viewed 1 April 2024, https://www.health.gov.au/our-work/national-response-to-syphilis. 
3. Carter, A; McManus, H; Ward, JS; Vickers, T et al. 2023, ‘Infectious syphilis in women and heterosexual men in major Australian cities: sentinel surveillance data, 2011-2019’, Medical Journal of Australia, vol. 218, no. 5, pp. 223-228, viewed 1 April 2024, https://www.mja.com.au/journal/2023/218/5/infectious-syphilis-women-and-heterosexual-men-major-australian-cities-sentinel#1. 
4. Cunningham, M 2021, ‘Syphilis epidemic in Melbourne suburbs: scientists use genomic sequencing to track STD’, The Age, 17 May, viewed 1 April 2024, https://www.theage.com.au/national/victoria/syphilis-epidemic-in-melbourne-suburbs-scientists-use-genomic-sequencing-to-track-std-20210511-p57qqv.html. 
5. Wu, MY; Gong, HZ; Hu, KR; Zheng, H et al. 2021, ‘Effect of syphilis infection on HIV acquisition: a systematic review and meta-analysis’, Sexually Transmitted Infections, vol. 97, no. 7, pp. 525-533, viewed 1 April 2024, https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8543214/. 
6. Australasian Society for HIV, Viral Hepatitis and Sexual Health Medicine (ASHM) 2021, Syphilis, Australian STI Management Guidelines for Use in Primary Care, viewed 1 April 2024, http://sti.guidelines.org.au/sexually-transmissible-infections/syphilis/. 
7. Victorian State Government Department of Health 2023, Congenital syphilis in Victoria, viewed 1 April 2024, https://www.health.vic.gov.au/health-advisories/congenital-syphilis-in-victoria.