Congenital syphilis, a preventable condition with severe outcomes, is rising in Australia due to gaps in prenatal care. Despite public health efforts, the incidence among women of reproductive age has surged, necessitating urgent action to prevent a continued increase in cases.
The resurgence of syphilis in Australia, particularly among women aged 15–44, has led to an alarming increase in congenital syphilis. Recent data shows infectious syphilis cases have climbed by 500% over the past decade, with a corresponding spike in mother-to-child transmission.
Congenital syphilis can cause miscarriage, stillbirth, neonatal death, or lifelong disability in over 50% of untreated cases. A review of congenital syphilis cases in Australia from 2011 to 2021 revealed that 25% resulted in stillbirth, and less than 40% of affected women were tested for syphilis during pregnancy. Nearly half of affected women had no record of antenatal care, highlighting critical gaps in prenatal health services.
The initial resurgence of syphilis was concentrated among men who have sex with men and in remote Aboriginal and Torres Strait Islander communities. Despite public health campaigns and increased testing, syphilis has continued to spread, leading to a rise in congenital cases. In 2023, 20 cases of congenital syphilis were reported, a significant increase from the median of four cases per year seen between 2011 and 2019.
The rise in congenital syphilis is likely linked to social determinants of health including homelessness, poverty, domestic violence, and discrimination in healthcare. Aboriginal and Torres Strait Islander women report syphilis rates 35 times higher than non-Indigenous women, exacerbated by structural barriers to healthcare access.
To address this crisis, it is essential to enhance syphilis testing and treatment during pregnancy, improve partner testing, and implement better monitoring systems. A holistic, culturally appropriate approach to care, particularly for Indigenous communities, is crucial. The World Health Organization aims to eliminate congenital syphilis, with a target of 95% of pregnant individuals being tested. Australia must act urgently to meet this goal and prevent further tragedy.
By Maya Caple