Key points
- Last year, 1695 syphilis cases were reported in Victoria.
- This number was the highest in more than three decades.
- Syphilis begins with the appearance of sores or ulcers, before developing into a rash.
Sexual health physicians are pushing for PCR testing for syphilis to be used widely amid a worsening epidemic in Melbourne that has led to the highest number of reported cases in decades.
Doctors say lessons learnt about coronavirus containment should now be applied to all sexually transmitted infections, including the potentially deadly syphilis.
Sexual health physician Marcus Chen.Credit:Joe Armao
Syphilis first appeared in the 15th century and had been almost eradicated, but cases are rising at an alarming rate in Australia and around the world.
Last year, 1695 cases were reported in Victoria, the highest annual number of infections in more than 30 years and almost four times the 446 cases detected a decade earlier. In 2021, 1524 cases were reported.
Data from the Victorian Health Department’s infectious disease surveillance report showed more than 260 cases of syphilis have already been detected this year. There has also been a surge in cases among women, which has led to babies being infected with the disease in the womb and dying for the first time in Victoria in 14 years.
The rise in cases has prompted researchers including Adjunct Professor Marcus Chen, from Alfred Health’s Melbourne Sexual Health Centre, to call for increased testing by GPs, as worrying clusters of the disease continue to emerge, predominantly in Melbourne’s outer west and south-east.
“This is a serious public health problem; there’s no question about that,” Chen said. “There has been a dramatic rise in recent years.”
Hotspots have emerged in the local government areas of Casey, Wyndham, Melton, Maribyrnong and Merri-bek.
There were 56 cases of syphilis detected in Melton last year and there have been at least 11 so far this year. In Casey, in the outer south-east, 47 cases were detected last year, and four infections have been found to date in 2023. In the inner-northern municipality of Merri-bek, formerly known as Moreland, 55 infections were reported last year. There have been three so far this year. In Maribyrnong, there were 41 cases reported last year, and this year’s number stands at seven.
Syphilis begins with an appearance of sores or ulcers, before developing into a rash. If untreated, it can eventually cause a brain infection, dementia and blindness. It can be cured with penicillin, but people may not seek treatment because they do not realise they have been infected, as syphilis is often asymptomatic following signs of the initial infection.
Sexual health physicians want PCR testing for syphilis to be used widely to help contain a growing epidemic in Melbourne.
As part of a recent study led by Chen, about 1300 PCR tests were carried out on samples taken from people in Melbourne who went to see their GP over symptoms of herpes, a viral skin disease that can be transmitted sexually.
The researchers were surprised to find that when the swabs were PCR-tested by pathologists, who screened them for herpes and syphilis, 18 people tested positive for syphilis. In about a third of the positive cases, the GP had not recommended the sample be tested for syphilis.
Chen said emerging research showed there was asymptomatic shedding of syphilis before the infection peaked in the secondary stage. Often an early indication of the disease was an ulcer, which might resemble herpes, prompting him to call for GPs to consider automatic testing for syphilis when they are screening for other STIs.
“What we want to do is pick up more syphilis cases in the primary stage before it gets to the more infectious secondary stage,” he said. “If we use PCR testing more broadly, then that’s a very good way to detect the disease early.”
Some experts have speculated that the growing spread of syphilis is partly linked to social media and online dating apps, which have resulted in a rise in casual sex, but Professor Chen said more research into the complexities of what was driving the epidemic was needed.
Professor Deborah Williamson, a Doherty Institute professor of microbiology, said rapid antigen point-of-care tests had emerged as the new frontier in infectious diseases during the pandemic.
“We need to have the same sort of changing mentality we had for COVID testing for STIs,” Williamson said. “We need to be looking at self-testing for STIs at home and making sure that people can test themselves and then be put into some treatment and care pathway.”
Williamson said the Doherty Institute was developing a rapid-at-home test for mpox, previously known as monkeypox.
She said genomic sequencing was also being used for sexually transmitted infections for the first time in Australia, including drug-resistant gonorrhea, which is also on the rise.
The technology works by analysing a virus or bacteria sample taken from a diagnosed patient, mapping out its entire genetic code and then comparing it with other cases to determine if there is a link.
Meanwhile, Australians heading to Sydney WorldPride who are eligible for mpox vaccination are being urged to get a jab before attending the global LGBTQ festival, which runs until March 5.
Globally, mpox cases have declined steeply since they peaked in August 2022, including in Australia, where no new cases have been recorded this year. But low-level transmission in other non-endemic countries is prompting health authorities to recommend festival attendees at risk of infection are vaccinated.
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