An outbreak of infectious syphilis, affecting rural and remote Aboriginal communities in the Far North and Eyre and Western regions of South Australia (SA), since November 2016 extended to metropolitan Adelaide in November 2018. As of August 2020, case numbers continue to increase across all regions. This outbreak is part of a multi-jurisdictional outbreak of syphilis occurring across northern Australia in predominantly rural and remote Aboriginal and Torres Strait Islander communities.
Syphilis is highly infectious during the first two years of infection. Pregnant women can transmit syphilis to their babies, which can result in perinatal death, premature delivery, and congenital abnormalities. In SA, three children have been born with congenital syphilis. Syphilis also increases the risk of HIV transmission.
Medical practitioners in the outbreak areas and surrounding regions are advised to:
All medical practitioners should:
Locating, testing, and treating partners of infectious cases is also important in controlling syphilis.
In response to the syphilis outbreak, in 2017 the Communicable Disease Control Branch formed the SA Syphilis Outbreak Working Group (the Working Group) comprised of representatives from various government, non-government and community-controlled health services. The Working Group’s role is to monitor and coordinate the state syphilis outbreak response, with the aim of concentrating immediate efforts to contain the current outbreak, while simultaneously seeking to develop sustainable, long term interventions designed to improve the sexual health of populations in outbreak affected areas and more broadly. In order to achieve this aim, the Working Group developed the South Australian Syphilis Outbreak Response Plan, 2019 (PDF 318KB) that has been endorsed by the Minister for Health and Wellbeing as a priority.
Since the commencement of the outbreak in South Australia, there have been two cases of congenital syphilis born to women who identify as Aboriginal, one in May 2020 and one in September 2020. The previous case of congenital syphilis was in 2017.
A Congenital Syphilis Review Group (the Review Group), comprised of a wide range of representative members, across government and non-government agencies, was established to investigate the issues surrounding the two more recent cases.
The Congenital Syphilis Case Review Report identifies a range of local system-level issues requiring attention, along with recommendations for review of clinical protocols, and prevention, education, community engagement and workforce development processes.
The Review Group also identified significant long term, system-wide, embedded issues that contribute to a lack of safety for Aboriginal mothers and pregnant women in accessing health and other government services and therefore have a significant negative impact on outcomes for mothers and their babies. These include ongoing experiences of institutionalised racism that are at the core of health and education inequities. Thus, the Review Group recommendations place significant focus on these issues.
The SA Syphilis Register is a secure, confidential, single statewide database that includes all laboratory positive syphilis cases diagnosed in Aboriginal and Torres Strait Islander South Australians that meet the syphilis national case definition. Register staff may undertake or assist with Partner Notification, (also known as contact tracing) for all contacts of Aboriginal and Torres Strait Islander cases, regardless of Aboriginality. Register staff contact partners (or coordinate the contacting of partners) with the aim of coordinating syphilis screening and treatment, where appropriate.
