Rising infections, preventable infant deaths and missed diagnoses are driving a push to normalise routine testing across all patient groups.
Australia’s escalating syphilis outbreak has triggered a new national response from ASHM, with the launch of a targeted awareness campaign aimed at healthcare professionals.
The move comes as fresh data reveals widespread uncertainty about testing and a reluctance to raise sexual health with patients.
Syphilis cases have more than doubled over the past decade and the infection has been declared a Communicable Disease Incident of National Significance, placing it alongside major public health threats requiring coordinated national action.
Syphilis remains a nationally notifiable disease, with 3546 infectious cases recorded in 2025 alongside 11 congenital cases and four infant deaths.
According to the Australian Centre for Disease Control’s National Notifiable Disease Surveillance System, there have been 216 cases of syphilis reported so far this year as of 19 March.
Despite this, a 2025 ASHM survey of more than 800 clinicians found that 54% did not feel confident about when to test or refer for syphilis, while only 38% believed it was their responsibility to initiate conversations about sexual health.
That gap between rising disease burden and clinical practice is now under scrutiny, particularly given the severity of outcomes when infections are missed.
Congenital syphilis continues to cause preventable harm, with 33 infant deaths recorded in Australia between 2016 and 2024.
In pregnancy, untreated infection can lead to miscarriage, stillbirth and premature birth, underscoring the stakes of early detection.
Although most clinicians report being equipped to test or refer for sexually transmitted infections, routine engagement appears limited.
Just 21% said they regularly discussed sexual health with patients, a disconnect experts said was fuelling ongoing transmission.
Melbourne GP and sexual health specialist Dr George Forgan-Smith told The Medical Republic that normalising these conversations was critical to reversing current trends, noting that testing remains simple but underutilised.
“The rates of syphilis doubled in the past 10 years, which is scary,” he said.
“I do believe that we had always demarked syphilis to particular groups of people, in particular men who have sex with men.
“From my perspective, that’s always been the case, but what we’re now seeing is that it’s across all demographics. All sexually active people are at risk of acquiring syphilis.
“Of course, there are particular groups of people who are at higher risk, and that’s women who are pregnant, people in indigenous communities and men who have sex with men.
“However, it’s not limited to that group of people. I think we need to move syphilis into the forefront, that as part of regular sexual health screening, and as part of regular antenatal screening, we have to include testing for syphilis.”
Compounding the challenge is the nature of the disease itself. Often described as “the great imitator”, syphilis can present with a wide range of symptoms that mimic other conditions, while up to half of those infected may be asymptomatic and only identified through blood testing.
“It’s one of the big masquerades, and it can show up in different ways,” Dr Forgan-Smith told TMR.
“We need to be highly suspicious of any genital sores or anything, they can even occur in the mouth and the back of the throat.
“The sores can be hidden away in places that we can’t see them. And because they’re painless, and because they go away in 10 days to three months, people just go, I must have bumped myself or something like that.
“I see a lot of people within my practice who have seen multiple doctors with rashes that aren’t resolving, no matter what steroid cream they use.
“We do the blood test, and it shows that they’ve been infected with syphilis for quite some time. Because that’s secondary syphilis. That’s something that shows up after the primary infection.”
He said the complications of untreated syphilis were significant, including neurosyphilis and ocular syphilis, which could lead to issues such as headaches, altered behaviour, dementia and paralysis.
“Oculus syphilis can lead to blindness, and all of this is so preventable,” he said.
Misunderstandings about testing pathways persist, with ASHM’s research indicating that many clinicians incorrectly assume syphilis screening is included in standard urine tests.
Sexual health researcher and clinician Dr Karen Freilich said blood testing for both syphilis and HIV should be routine in asymptomatic STI screening.
“It’s an easy to test and easy to treat disease, but our research found that there are still knowledge gaps with Australian healthcare providers,” she said.
“Two thirds of the healthcare providers that were surveyed think that a syphilis test is part of a urine test, and that’s not correct.”
Related
In response to these findings, ASHM has launched a National Syphilis Awareness Campaign to equip healthcare professionals with practical tools for early detection and testing.
The campaign will target doctors, nurses and community workers across Australia to help spread the message across the healthcare sector.
“We know knowledge gaps limit healthcare workers’ ability to identify risk and respond early,” said ASHM CEO, Alexis Apostolellis.
“This is why ASHM Health is focused on rolling out targeted education to promote awareness and understanding related to syphilis, to ensure it’s on all healthcare professional’s radars and to ensure that we are doing everything we can to stop the spread.”
Dr Forgan-Smith told TMR that “asking to do a syphilis test should be as easy as asking for a cup of tea”.
“How do you like your tea? Milk and sugar? Great, by the way, as routine testing as part of your sexual health, of course, we’re going to include syphilis, HIV, we’re going to check for chlamydia and gonorrhoea,” he said.
“It’s just the standard test. We do it for everybody.
“We need to be able to sit with our patients. And if we’re uncomfortable, they’ll feel uncomfortable.
“So it’s really important that everybody it’s as laissez-faire as, ‘we’ll do a full blood count. Hey, while we’re there, why don’t we just do a sexual health screening’.
“Let’s make it a very normal, unloaded, unburdened question. It should be rolling off the tongue as if we were doing a blood pressure.”
