28 January 2020

Syphilis crisis prompts calls for greater funding

Clinical Sex

Syphilis rates are rising dramatically in Victoria, prompting calls to better fund public sexual health clinics.

Experts are also calling for increased screening and testing, particularly during pregnancy, in the wake of foetal deaths from congenital syphilis.

The sexually transmitted infection appeared to be well under control in Victoria by the 1990s, down to as few as two cases a year in 1999. But numbers have been dramatically rising since.

There were 322 cases of infectious syphilis in Victoria in 2011, but this had doubled by 2014. The most recent data has revealed that there were 1631 confirmed cases over 2019.

The biggest outbreak was in the Melbourne City Council region, with 145 cases last year – up from 47 in 2014. Rates in nearby areas such as Port Phillip, Stonnington and Yarra have also increased.

An important demographic shift is also underway. Men who have sex with men have historically accounted for most of the reported cases of syphilis, with only a handful of women of reproductive age contracting the disease in 2014.

But by 2019, more than 100 women of reproductive age were reported with syphilis.

This has coincided with a re-emergence of congenital syphilis, for the first time since 2004. Last year, the state’s Department of Health reported four confirmed cases of congenital syphilis and two foetal deaths.

“When you have more syphilis around, catastrophes become inevitable,” said Professor Basil Donovan, head of the sexual health program at the Kirby Institute at UNSW.

He called for increased testing rates, particularly from GPs doing shared care for pregnancy.

“If you’re taking blood for any reason, add a syphilis test,” he told The Medical Republic. “Because we have had far too many congenital cases, and lost pregnancies.” 

The rise of syphilis isn’t a problem for Melbourne alone.

“We have actually had a resurgence in heterosexual syphilis in most Australian cities in recent years,” Professor Donovan said. “But not to the same extent.”

“There is also a very large resurgence in New Zealand as well, and that has been associated with cutbacks in public sexual health services.”

Professor Kit Fairley, director of the Melbourne Sexual Health Clinic, also attributed this “crisis” of syphilis and gonorrhoea infections in Victoria to a lack of health services.

In comparison with NSW, which boasts 37 publicly funded sexual health clinics, Victoria only has one major clinic in Melbourne and a smaller part-time one in Geelong.

There are 10 clinics in Sydney alone.

Attendance rates at Professor Fairley’s Melbourne clinic has quadrupled in the last two decades, but funding has remained relatively stagnant, he said in an article on Monash University’s Lens site in December.

“I’m not saying that if a whole lot of new services are provided, all the STIs will disappear overnight,” he said. “What I’m saying is that we’re entering a new and unique period of STI control without the most powerful measure – accessible healthcare – operating properly.”

These services are important, because while GPs do the majority of STI diagnoses, public health services can do the contact tracing and following up necessary to contain local outbreaks, Professor Donovan said.