Recent data show a concerning rise in cases of infectious syphilis among women aged 15 to 44 in Australia, which has led to an increase in transmission from pregnant individuals to their children, known as congenital syphilis. This condition can be easily prevented by timely testing and treatment during pregnancy. If left untreated, congenital syphilis can result in severe consequences in over 50% of cases, such as miscarriage, stillbirth, neonatal death, or permanent disability. Upon reviewing congenital syphilis cases in Australia from 2011 to 2021, we found that 25% of cases tragically resulted in stillbirth. Among birthing parents of babies with congenital syphilis, less than 40% were tested for the disease during pregnancy, and almost half had no record of receiving any antenatal care.
Experts have long been aware of the syphilis resurgence in Australia. However, our analysis is the first to highlight significant gaps in antenatal care, which have led to tragic consequences. Between 2011 and 2021, the incidence of infectious syphilis in women aged 15 to 44 increased by over 500%, jumping from 141 cases in 2011 to 902 in 2021. This rise reflects a broader increase among young people. Before 2011, infectious syphilis was rare. When cases began to rise, they initially appeared in men with male partners in cities and in young heterosexual individuals in remote Aboriginal and Torres Strait Islander communities. Health authorities responded with increased testing and public health campaigns to reduce transmission. Despite these efforts, syphilis cases have continued to climb, spreading throughout Australia. There has been considerable investment from federal, state, and territory governments for improving syphilis detection and treatment, including community screening, mass media campaigns, education for healthcare workers, and point-of-care rapid testing.
Congenital syphilis cases in Australia have been steadily increasing, following a global trend. From 2011 to 2019, Australia reported a median of four congenital syphilis cases annually, which rose to 17 cases in 2020, and 15 cases in 2021 and 2022. In 2023, 20 cases were reported. Although these numbers may seem small, without intervention, this upward trend could lead to more deaths and permanent disabilities in babies with a preventable disease. It is crucial to focus on reducing syphilis transmissions and mitigating the impact of syphilis during pregnancy. Pregnancy testing practices range from a single test at the first antenatal appointment to five tests during the pregnancy for high-risk individuals or those living in outbreak areas in remote Australia. State and territory health departments provide varying recommendations, but efforts are underway to standardize guidelines.
In many cases, no screening occurs at all. The rise in infectious and congenital syphilis is likely linked to social determinants of health, including homelessness, unstable housing, poverty, domestic violence, mental health issues, substance abuse, cultural and language barriers, racism, and discrimination in healthcare settings. Our study found that Aboriginal and Torres Strait Islander women experienced syphilis rates 35 times higher than non-Indigenous women, likely due to the enduring effects of colonization, along with structural obstacles and healthcare access issues.
To reverse this trend and reduce the number of babies affected by congenital syphilis, we need to urgently: explore accessible models of care for pregnant women engaging with the health system, enhance partner testing and treatment, and improve surveillance of pregnancy testing. It is important to ensure a holistic approach to care for pregnant women, co-designed in collaboration with affected communities. For Aboriginal and Torres Strait Islander women, this could include increased access to Birthing on Country programs. The World Health Organization also recommends routine testing of partners for syphilis to help eliminate congenital syphilis.
Moreover, better monitoring of syphilis testing during pregnancy is necessary. The World Health Organization has set a goal to eliminate congenital syphilis globally, aiming for 95% of pregnant individuals to be tested during pregnancy. Currently, there is no way to measure how close Australia is to achieving this target. Congenital syphilis is entirely preventable, and it is unfortunate when any pregnancy results in such an outcome.