Recurrent shortages of the only recommended syphilis treatment in pregnancy undermine Australia’s response to a growing outbreak, according to roundtable of health leaders.
Short-term actions to combat congenital syphilis are achievable within 12 months, but eliminating the disease requires addressing structural barriers and workforce shortages first.
The second national congenital syphilis roundtable, convened by the National Aboriginal Community Controlled Health Organisation (NACCHO) and the Australasian Society for HIV, Viral Hepatitis and Sexual Health Medicine (ASHM) in March, put forward more than 25 short-term actions for the federal government’s 2026 syphilis response plan.
The report’s actions spanned eight priority domains – governance, antenatal care, perinatal and neonatal care, testing, workforce capacity, data and surveillance, medicines supply, and communications.
Syphilis has been a Communicable Disease Incident of National Significance (CDINS) since August 2025.
There were 91 cases of congenital syphilis between 2020 and 2025. In that time, 33 babies died.
Transmission from a pregnant person to their baby is one of the most serious, preventable outcomes of this outbreak – beginning with access to antenatal care, the report said.
However, geographic remoteness, lack of safe and diverse environments, STI stigma, substance use, homelessness, and domestic violence were key barriers to care and system engagement.
Syphilis’ CDINS status, continued workforce constraints necessitate expanding Despite clinicians’ practice scope, upskilling primary-care teams, and adding MBS items so clinicians could work to their full scope, the report read.
Thus, working with colleges and accrediting bodies like AHPRA to embed standardised congenital syphilis protocols into professional training requirements and ongoing education for allied health was a top long-term priority.
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Among the proposed actions was to ensure updated antenatal syphilis testing guidelines were implemented consistently – some facilities’ guidelines were outdated, and some healthcare workers were unaware of the changes.
The report also found that a lack of universal Neonatal Management Plans for all individuals who test positive for syphilis risks fragmented care, delayed diagnosis and congenital syphilis in newborns.
There were also significant data chasms in testing and care for infants born to people with syphilis, limiting understanding of the full burden of congenital syphilis.
The roundtable said capturing testing, treatment and outcomes for these infants was essential in the short term, but required implementing a ‘no wrong door’ syphilis testing approach across emergency departments, alcohol and other drug services and correctional settings.
The syphilis notification rate for Aboriginal and Torres Strait Islander people was approximately seven times higher than for non-Indigenous Australians.
The report concluded that community-led antenatal care models amongst priority populations, including ACCHOs and Birthing on Country programs, are effective and require expansion in the long term. But it can’t be achieved by this sector alone.
“Collective responsibility is not a platitude in this context; it is a clinical and public health imperative,” the report read.
Shortages of benzathine benzylpenicillin-G (BPG), the only recommended treatment for syphilis during pregnancy and breastfeeding, continues to undermine timely treatment, often with “devastating impact”.
Prolonged and recurrent BPG shortages, the TGA said, pointed once again to a lack of accurate historical usage data, which could significantly underestimate need and underscore the need for updated forecast tools.
It warned that workforce shortages and data gaps, flagged at the first roundtable in 2024, remain largely unresolved.
The report called for support from the Blood Borne Viruses and Sexually Transmissible Standing Committee to help jurisdictions implement governance arrangements in partnership with affiliate NACCHOs and their jurisdictions.
