Syphilis Testing in Antenatal Settings: Train the Trainer

Escalating Syphilis Crisis

Syphilis notifications in Australia have roughly doubled over the past decade, with 5,866 cases in 2024 and continued high numbers into 2025. The rise has shifted from being concentrated in specific populations to affecting broader groups, including women of reproductive age across urban, regional, and remote areas.

The most severe consequence is congenital syphilis, where untreated infection passes from mother to foetus, leading to stillbirth, neonatal death, or lifelong disabilities. Between 2016 and 2024, 99 congenital cases were reported, with 33 infant deaths—over half among Aboriginal and Torres Strait Islander babies. In 2023, the peak year, 20 congenital cases resulted in 10 deaths.

By mid-2025, 11 congenital cases had already caused four deaths, prompting the August 2025 declaration of a national incident. This rare step signals urgency for coordinated response, building on the 2021 National Strategic Approach that prioritised eliminating congenital syphilis.

Recent guideline updates in late 2024 and early 2025 recommend universal syphilis testing at the first antenatal visit, 26-28 weeks, and 36 weeks or birth. Previously, some jurisdictions like Victoria tested only once routinely, with extras for high-risk groups. The change acknowledges asymptomatic infections in up to 50% of pregnant women and rising transmission risks as pregnancy advances.

Non-obvious tensions include persistent barriers in remote areas—geographical, logistical, and cultural—that undermine screening effectiveness even where programs exist. Disproportionate impact on Indigenous communities highlights inequities in healthcare access and social determinants driving spread. While penicillin offers simple, cheap cure, late or missed diagnoses in pregnancy turn a treatable condition into irreversible harm.

Stakeholders face trade-offs between expanded routine testing (increasing workload and costs) and targeted approaches, but inaction has proven costlier in lives lost and long-term health burdens.