Children infected with syphilis are part of a growing tragedy – one that could easily be prevented

Data just posted online shows a worrying enhance in cases of infectious syphilis among Australian women aged 15-44 (known as ‘childbearing age’) and a subsequent enhance in transmission from pregnant mother to child. This is called congenital syphilis.

Congenital syphilis is easily prevented by timely testing and treatment of syphilis during pregnancy. Untreated congenital syphilis can have devastating consequences in more than 50% of cases they involve miscarriage, stillbirth, neonatal death and constant disability.

We looked at all cases of congenital syphilis in Australia between 2011 and 2021 and found that tragically 25% were stillborn. For parents of babies with congenital syphilis, we found that less than 40% were tested for syphilis during pregnancy. Almost half had no record of receiving antenatal care.

The experts were aware of the renewed rise in syphilis cases in Australia for some time. But our analysis is the first to reveal significant gaps in prenatal care that lead to devastating outcomes.

The number of syphilis cases has been increasing for a decade

In the years 2011–2021 infectious syphilis disease rate increased by more than 500% among women aged 15-44, from 141 in 2011 to 902 in 2021. This reflects growth more broadly Among young people.

Before 2011, infectious syphilis was uncommon. When cases began to enhance, they initially affected men with male sexual partners in metropolitan areas and youthful heterosexuals in remote Aboriginal and Torres Strait Islander communities. Health departments increased testing and initiated public health campaigns to reduce transmission.

Despite these efforts, cases of syphilis still occur. it was still growingand initial outbreaks spread throughout Australia. Federal, state and territory governments have made significant investments to enhance syphilis detection and treatment, including community screening, mass media campaigns, education of health workers and rapid test results through point-of-care testing.

In Australia, the number of cases of congenital syphilis is also steadily increasing, reflecting international trends.

In the years 2011-2019 the median was four cases of congenital syphilis per year In Australia, the number of cases increased to 17 in 2020 and to 15 in 2021 and 2022. In 2023, 20 cases were reported.

These numbers may seem compact. However, without action, this upward trend will lead to more deaths and constant disabilities in children with congenital syphilis, a preventable disease.

What can we do about it?

It is time to focus on reducing syphilis infections and in particular on the effects of syphilis on pregnancy.

The range of tests during pregnancy ranges from one test at the first antenatal visit to five tests during pregnancy if the pregnant woman is considered high risk or lives in an outbreak area in remote Australia. Recommendations are provided by state and territory health departments and vary across Australia, but work is underway to standardise guidelines.

However, in many cases, no screening is performed at all.

There is a probable enhance in the incidence of infectious and congenital syphilis. related to social social determinants of health (non-medical factors influencing health outcomes), including homelessness, housing instability, poverty, domestic violence, mental illness, drug and alcohol apply, cultural or language barriers, racism and discrimination in health care.

Our test Aboriginal and Torres Strait Islander women were found to have 35 times higher rates of syphilis than non-Indigenous women. This is likely due to the long-term effects of colonisation, as well as structural and access barriers to healthcare.

To reverse the current trend of increasing numbers of children with congenital syphilis, we urgently need to:

• explore available models of care for pregnant women wherever they come into contact with the healthcare system

• improve partner testing and treatment

• improve supervision of testing during pregnancy.

Not just medical tests

For pregnant women, we need to ensure a holistic approach to care co-designed with affected communities. For Aboriginal and Torres Strait Islander women, this may include greater access to “Birth in the Country” Programs.

The World Health Organization (WHO) also recommends partners are routinely tested for syphilis to eliminate congenital syphilis.

We need better monitoring of syphilis testing in pregnancy. The WHO has set a global target for eliminating congenital syphilis, with the goal of 95% of pregnant women being tested for syphilis during pregnancy. There is currently no way in Australia to know how close or far we are from this target.

Congenital syphilis is completely preventable, and if a pregnancy ends in such a complication, it is a tragedy.

The authors would like to thank Lorraine Anderson of Kimberley Aboriginal Medical Services for providing substantive support for the study on which this article is based.