“To us in the field, it is just such a dreadful thing to see because we know that it is completely preventable,” said Associate Professor Marcus Chen, from Alfred Health’s Melbourne Sexual Health Centre.
“You really shouldn’t be seeing babies with syphilis infections in Melbourne in 2020. These are tragic and avoidable cases.”
Victoria has recorded 1316 cases of syphilis this year, compared to 1678 cases last year, but Professor Chen said screening of people without symptoms had plummeted by almost 70 per cent during the pandemic so it was likely the number of infections were far higher.
‘Testing people who don’t have any symptoms is really critical for syphilis because many people can be asymptomatic,” he said. “Despite COVID, syphilis cases really haven’t fallen away. By the end of the year, I suspect the number of cases will be higher than 2019.”
While the disease had previously circulated among men who had sex with other men, it has now infiltrated Melbourne’s outer suburbs and a growing number of women are becoming infected.
This year, 172 infections have been detected in women, compared to 176 cases last year.
Three cases of congenital syphilis have been reported in Victoria this year. Six cases (two per year) were reported between between 2017 and 2019, according to state health figures.
“We think what is happening now is that there has been sustained transmission between heterosexual men and women,” Professor Chen said.
Syphilis, first emerged in the 15th century, and begins with an appearance of sores or ulcers, before developing into a rash. If untreated, it can eventually cause a brain infection and dementia.
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.
Obstetrician and sexual health physician Kathryn Cook said the deaths of the babies were avoidable tragedies with doctors increasingly seeing more acute cases of syphilis, some of which were being detected later in pregnancy.
“It is deeply, deeply distressing and very concerning,” Dr Cook said. “This is a devastating disease that is totally preventable. Any infection which gets into the heterosexual population will eventually be exhibited in pregnancy so it’s a very much marker, if you like, of the epidemic of syphilis.”
Up to 40 percent of infants with syphilis are stillborn.
Dr Cook said syphilis could also cause miscarriage, prematurity, low birth weight and other manifestations after birth if left untreated including failure to thrive, enlarged liver or spleen, deformities and deafness.
While every woman is screened for the disease in their first trimester, Dr Cook said a second re-screening for the disease should be considered for woman at 28 weeks to pick up further cases.
“For every congenital syphilis case, there are many more cases which are treated in pregnancy so we are picking up cases,” she said. “It is critical there is greater awareness because it is a disease that is not on everybody’s radar.”
Pregnant women who have been diagnosed with syphilis can be cured with an injection of long-acting benzathine penicillin which is able to cross the placenta.
Professor Chen said many women being infected with syphilis were from socio-economically disadvantaged backgrounds and faced barriers in accessing medical support.
“They may not be engaged in antenatal care and, in some cases, they are presenting very late in pregnancy,” he said.
Heterosexual men were also extremely hard to engage in sexual health care, Professor Chen said.
Significant outbreaks of the highly infectious disease have being detected in local government areas including Frankston, Melton, inner Melbourne, Casey, Darebin and Stonnington. In Frankston, 32 cases have been reported this year, up from 19 last year.
Meanwhile, in Casey, which takes in south-eastern suburbs including Berwick and Cranbourne, 32 syphilis cases have been recorded, up from 27 last year.
The heavily populated Melbourne City Council municipality has recorded the most syphilis cases with 146 infections recorded this year, compared to 150 last year.”
The disease has also struck Indigenous communities in Australia’s far north and South Australia, with at least six babies dying since 2011.
Some experts have speculated the growing spread of syphilis was 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.
Reported cases of other sexually transmitted diseases such as chlamydia and gonorrhea have dropped this year, but Professor Chen said screening had declined so it was difficult to get a clear picture of the true rate of disease.
To combat rising rates of syphilis, Alfred Health has established the Victorian Sexual Health Network, which is operating at three general practice clinics including Kings Park Medical Centre in Hillside in the city’s north-west, Mediclinic Clayton in the south-east, and Tarneit Family Medical and Dental Practice in Melbourne’s west.
The network of doctors, being overseen by the Melbourne Sexual Health Centre, is working with staff and local pharmacies to ensure there is supply of HIV-prevention medications and antibiotic treatment for syphilis and gonorrhoea on site.
Melissa Cunningham is The Age’s health reporter.