GPs are central to case detection, antenatal screening and contact tracing amid ongoing treatment supply challenges.
General practitioners are at the forefront of Australia’s response to the resurgence of syphilis, playing a vital role in early detection, treatment, prevention and public health awareness.
Earlier this month, Australia’s chief medical officer Professor Michael Kidd declared syphilis a Communicable Disease Incident of National Significance.
The move is a response to rising cases of infectious syphilis across Australia, resulting in tragic cases of congenital syphilis and infant deaths.
Dr Sara Whitburn, chair of the RACGP Specific Interests Sexual Health Medicine, told The Medical Republic there were plenty of resources to support GPs in their response to the declaration.
“GPs play a critical role in the early detection, treatment and prevention of syphilis,” she said.
“Around 50% of people will have no symptoms and will only be diagnosed by screening with serological testing.”
In 2023, Australia saw record high notifications of infectious syphilis (6566 cases), as well a 20 cases of congenital syphilis, resulting in 10 infant deaths.
In 2024, the number of cases remained high, with 5968 cases of infectious syphilis and 10 cases of congenital syphilis, resulting in four infant deaths.
This year, as of 6 August, Australia has recorded 3546 cases of infectious syphilis, and 11 cases of congenital syphilis, leading to four infant deaths.
In 2025, notifications among women of reproductive age are expected to be similar to 2023 when notifications in this group peaked.
Non-Indigenous men account for almost three-quarters of infectious syphilis cases. Recent reductions in notifications overall are mostly associated with this group. Aboriginal and Torres Strait Islander people continue to be disproportionately affected, with infectious syphilis notification rates seven times higher than those of non-Indigenous Australians overall in 2024.
From the 99 cases of congenital syphilis reported between 2016 and 2024, 33 infants died – and more than half (58%) were Aboriginal and Torres Strait Islander infants.
“I am very concerned about the ongoing impact of syphilis on public health,” said Professor Kidd.
“Syphilis is preventable and is easy to treat if found early. Testing and treatment are simple and accessible. Congenital syphilis can be completely prevented through early detection and treatment of syphilis in pregnant people and their partners.”
“But, similar to other sexually transmissible infections (STIs), syphilis often shows no symptoms and can go undetected and untreated. This can lead to serious health problems, especially for pregnant people and their babies.”
Dr Whitburn said several new and updated resources have been developed to support clinicians.
ASHM has created a syphilis decision-making tool that provides practical guidance on presentations, investigations and treatment, available through the ASHM Syphilis Learning Hub.
The Australian STI Management Guidelines also provide comprehensive clinical information and link directly to ASHM resources.
In addition, the RACGP has produced an article in the Australian Journal of General Practiceexamining the resurgence of syphilis in Australia and released a video demonstrating how to administer benzathine penicillin injections.
“GPs can stay up to date by bookmarking and regularly reviewing the ASHM and Australian STI Guidelines websites, which are routinely updated to reflect current evidence and epidemiology,” Dr Whitburn added.
The RACGP recommends that syphilis screening form part of routine asymptomatic STI testing, with particular emphasis on high-risk groups.
This includes people who can become pregnant, who should be screened before pregnancy, at the first antenatal visit, again at 28–32 weeks, and at delivery.
Men who have sex with men should be tested every three months as part of comprehensive STI screening.
Screening is also advised following a change of sexual partner, when another STI is diagnosed, if symptoms are present, or when unexplained clinical signs such as rash, alopecia, fever, lymphadenopathy or abnormal liver function occur.
Dr Whitburn said GPs could implement opportunistic testing by integrating syphilis screening into routine sexual and reproductive health care, including cervical screening, contraception consultations, pregnancy planning, Aboriginal and Torres Strait Islander health assessments and 40–49-year health checks.
Opportunistic annual testing is also recommended for people under 30 and Aboriginal and Torres Strait Islander people under 35 in remote areas who are not in stable monogamous relationships.
Self-collected swabs, first-pass urine and blood tests are accessible through pathology providers, many of which also offer electronic request services and SMS notifications to improve patient convenience.
“GPs can support awareness by displaying posters about syphilis testing during pregnancy in waiting rooms, sharing information on clinic websites about rising syphilis rates and the importance of testing and by offering opportunistic testing,” she told TMR.
In addition, GPs were central to contact tracing, which was vital for preventing reinfection and further transmission, she said.
Sexual contacts of pregnant patients should be presumptively treated immediately, and the diagnosing clinician has the responsibility to initiate and document contact tracing discussions. Syphilis is a notifiable disease in all states, and some jurisdictions maintain a syphilis register.
Resources such as the Australasian Contact Tracing Guidelines, local Public Health Units, and the Let Them Know service, which allows patients to notify partners anonymously via SMS or email, are available to support GPs in this process.
Syphilis is a notifiable disease in all states and territories, and some jurisdictions maintain a syphilis register to support follow-up.
One ongoing challenge compounding the problem is the current shortage of benzathine benzylpenicillin, the recommended first-line treatment for syphilis.
The TGA has approved an overseas product, but supply may vary, and GPs may need to liaise with local pharmacies or sexual health clinics to secure stock.
“The Australian STI guidelines provided advice on using doxycycline for non-pregnant people suspected or diagnosed with syphilis and their contacts, which GPs may need to use if they are unable to access benzathine benzylpenicillin,” said Dr Whitburn.
