Syphilis Testing in Antenatal Settings: Train the Trainer

Syphilis Resurgence in Pregnancy

Syphilis notifications in Australia have more than doubled over the past decade, reaching 5,866 diagnoses in 2024 alone. The rise has been particularly sharp among women of reproductive age, quadrupling in that group and driving a parallel increase in congenital syphilis—transmission from mother to foetus that can cause miscarriage, stillbirth, neonatal death, or lifelong disabilities in survivors.

Between 2016 and 2024, Australia recorded 99 cases of congenital syphilis and 33 related deaths, with more than half among First Nations infants. In 2023, ten such deaths marked a grim peak, and 2025 has already seen additional stillbirths and infected newborns in states like Western Australia.

The surge stems from multiple factors: reduced condom use in some populations, limited healthcare access in remote and Indigenous communities, stigma around testing, and insufficient awareness among providers and the public. Heterosexual transmission now contributes significantly alongside ongoing cases in gay and bisexual men.

In response, the Australian Government declared syphilis a Communicable Disease Incident of National Significance on 7 August 2025, activating a national coordination framework. This includes expanded point-of-care testing, simplified treatment pathways, and targeted efforts in high-burden areas. Updated national guidelines from November 2024 now require universal syphilis screening three times during every pregnancy, a major shift from earlier practices that often limited repeat tests to high-risk groups.

Implementation faces tensions: while universal testing aims to catch infections early, logistical challenges in rural settings and workforce shortages risk uneven rollout. Critics note that without addressing underlying inequities—such as cultural barriers to care and social determinants—testing alone may not halt transmission chains.

The stakes are immediate and severe. Untreated maternal syphilis carries up to 40% risk of adverse outcomes, including stillbirth. Preventable infant deaths underscore the human cost, while each case burdens health systems with intensive neonatal care and long-term support for disabilities.