New Zealand has seen an increase in syphilis notifications in recent years. Following a local outbreak in 2010 cases locally have been sporadic but there has been a spike in notifications in the MidCentral region over the last few weeks with evidence of local transmission.
Dr Anne Robertson, Medical Head, Sexual Health Service says: “As recent evidence from the local measles outbreak has demonstrated, case finding and tracking of contacts brings an epidemic under control. Unlike measles details of cases will not be reported because of the stigma associated with Sexually Transmitted Infections (STIs).”
Syphilis is a bacterial infection and is sexually transmitted by direct transmission with infectious lesions or for babies vertically though the placenta.
In 2014, 95.7 percent of cases notified in New Zealand were male, the majority of whom have male sexual contacts. Female cases are currently uncommon but if pregnant women acquire infection after the time they have their booking bloods there is a risk of neonatal infection.
Syphilis is diagnosed by blood tests. False positive results can occur with the initial screening test and the laboratory automatically carries out additional testing on reactive result samples. Old infection will often give persistently positive results which are usually low level. Following a high risk exposure testing should be repeated at six and 12 weeks.
Syphilis is the great mimicker – symptoms can mimic a number of other disorders. Initial infection in the genital area, mouth or anus causes an ulcer which is often painless and not always noticed (primary syphilis). In 25 percent of people symptoms of secondary syphilis occur after 4-10 weeks including a rash, typically involving hands and feet but often very faint and non-specific. Other symptoms can include hair loss, fatigue, abnormal liver function and nephritis.
The infection usually then becomes dormant and can re-emerge after several years presenting with neurological or cardiovascular symptoms or skin lesions. However, in some individuals eye and neurological symptoms e.g meningitis can occur at the secondary stage. Without treatment one third of individuals with infection will go on to develop complications.
Testing should be offered as part of routine STI testing or to individuals presenting with symptoms of possible syphilis. It is recommended that men who have male partners should be offered annual testing (along with HIV testing), and for those with frequent change of partners every three months. All pregnant women are screened for syphilis at booking.
Syphilis is treated by injectable penicillin. The duration of treatment depends on whether infection is early or late. If a person is allergic to penicillin desensitisation can be considered. Other antibiotics may be effective but there is less information available on their effectiveness.
Sexual contacts require testing and treatment and if exposed to early infection treatment is offered.
Testing is done by GPs or practice nurses, Youth One Stop Shop, or the MidCentral Specialist Sexual Health Service (Phone: 0800 808 602 or (06) 350 8602)
Contact: Communications Unit (06) 350-8945