Given the ongoing syphilis outbreak affecting remote communities in Queensland, the Northern Territory, Western Australia and South Australia, clinicians need to be able to quickly access syphilis testing and treatment guidelines for the cross-jurisdictional enhanced response. This page provides links to clinical guidelines and other resources specifically relating to syphilis testing and treatment, including antenatal guidelines.

National clinical guidelines for syphilis

Screening: 2018 National Guidelines for Syphilis – pages 18 to 19

Offer STI/syphilis testing to sexually active young people in outbreak areas:

• as part of any consultation (opportunistically) for 15–29 year old’s
• as part of Adult Health Checks for 15-35 year old’s
• if patient asks to be tested

Treatment: 2018 National Guidelines for Syphilis – pages 16 to 17

Antenatal – National antenatal care guidelines for syphilis

Pregnancy Care Guidelines: Routine maternal health tests: Syphilis

Key points

• In syphilis outbreak areas, to prevent cases of congenital syphilis routinely offer syphilis testing to pregnant women and new mothers:
  • At antenatal booking visit
  • At 28 weeks antenatal check
  • At 36 weeks antenatal check
  • At delivery
• Seek advice from an expert in sexual health or infectious diseases regarding the care of women who test positive, and their partners.
• Ensure contact tracing (including offering testing and treatment to identified contacts) is carried out. Involve an expert in contact tracing if required or seek advice from a sexual health or other relevant expert.
• For women with newly confirmed infectious syphilis, the guidelines recommend an intramuscular dose of 1.8g (given as two 900mg injections) benzathine penicillin as soon as possible, ensuring that women receive treatment at least 30 days before the estimated date of birth to ensure adequate treatment before the birth.
• In areas affected by the syphilis outbreak, where a Point of Care syphilis test is reactive, treat the woman as soon as possible without waiting for confirmatory testing, particularly if there is a risk of loss to follow-up.
• First dose of benzathine penicillin must be administered at a minimum of 30 days prior to delivery, with a demonstrated four-fold (two-titre) drop in maternal RPR prior to birth. If these conditions have not been satisfied the baby should be examined, investigated and treatment for congenital syphilis considered. Specialist paediatric review is recommended.

Additional Clinical Resources on Syphilis

National

• Remote Primary Health manuals: CARPA STM and Women’s Business Manual

Northern territory

• NT Guidelines for the Management of Sexually Transmitted Infections in the Primary Health Care setting
• Congenital syphilis guidelines for the Northern Territory

Western Australia

• Silver book – Guidelines for managing sexually transmitted infections and blood-borne viruses: syphilis

South Australia

• SA Health Infectious syphilis outbreak in SA, Syphilis diagnosis and management and Factsheet for Health professionals
• SA Perinatal Practice Guidelines – Syphilis in Pregnancy

Queensland

• Queensland Clinical Guideline: Syphilis in pregnancy and Guideline Supplement Scroll down to “Syphilis in pregnancy”
• Queensland Health Communicable Disease Control Guidance – Syphilis

Young Deadly Free is a project by the University of Queensland Poche Centre for Indigenous Health (formerly the South Australian Health and Medical Research Institute). © UQ POCHE 2024