Tackling the syphilis outbreak in Aboriginal and Torres Strait Islander communities

Syphilis is a serious sexually transmissible infection (STI) caused by the Treponema pallidum subspecies pallidum bacterium. Syphilis can affect both men and women and in pregnant women it can lead to birth complications, congenital syphilis and miscarriages. It has a complex disease progression and early symptoms are often unnoticed. Left untreated, it can have significant health effects in several organ systems. Syphilis can be successfully treated with long-acting penicillin injections.

There is an ongoing outbreak of infectious syphilis affecting young Aboriginal and Torres Strait Islander people, predominately aged between 15 and 29 years, living in northern, central and southern Australia.

The outbreak began in northern Queensland in January 2011, spreading to the Northern Territory in July 2013, Western Australia in June 2014 and since November 2016 to South Australia. Since the commencement of the syphilis outbreak in 2011 to 30 June 2019, there have been 2,852 cases of infectious syphilis and 16 congenital syphilis cases associated with the outbreak regions of northern and central Australia. Of the 16 congenital syphilis cases, seven infants are reported to have died from the condition (all in Queensland, the most recent in September 2018). More detailed information on outbreak cases is located on the Syphilis Outbreak website of the Australian Department of Health.

The Enhanced Response to addressing STI (and BBV) in Indigenous populations is a national Action Plan for responding to the syphilis outbreak. The Australian Government has committed $21.2 million over four years (2017-18 to 2020-21) to the enhanced response and is rolling out a phased approach with targeted Aboriginal Community Controlled Health Services (ACCHS), employing additional sexual health staff to enable increased testing and community education. This implements the ‘test and treat’ model identified in the national Action Plan.

Nineteen ACCHS are funded under the phased approach. Phase 1 commenced from 1 August 2018 at ACCHS in Townsville, Cairns and Darwin; Phase 2 commenced from 10 October 2018 at ACCHS in East Arnhem Land (NT), the Katherine Region (NT), and in the Kimberley; and Phase 3 commenced from 4 April 2019 at ACCHS in Western Arnhem Land (NT); Western, Eyre, Far North and Adelaide regions of SA; and the Pilbara and Western Kimberley Regions of WA.

The Australian Government is also supporting the use of syphilis point-of-care test (PoCT) kits in outbreak regions, providing kits and training to ACCHS, in consultation with jurisdictions and NACCHO. The use of a PoCT enables immediate treatment, compared to an up to two-week turnaround for a traditional blood test which is further complicated by the movement of people.

The enhanced response involves multi-strategy Aboriginal and Torres Strait Islander community awareness, education and testing campaigns for syphilis and other STIs, including the South Australian Health and Medical Research Institute (SAHMRI) Young Deadly Free syphilis campaign.

The four affected jurisdictions are also implementing or enhancing disease control interventions in line with the national Action Plan.
They are using opportunistic and community screening/testing, particularly among young sexually active people aged 15-29 years and providing immediate treatment to people who are symptomatic (e.g. genital ulceration), have tested positive for syphilis or are sexual contacts of cases. There is also reinforcement and focus on antenatal screening for syphilis, with particular attention paid to recommended guidelines for the ‘at risk’ population; public health alerts, health protection education and campaigns; and active follow up of cases.