In this episode, Dr Tim Koh speaks with Dr Grace Phua, a GP and public health clinician from the Health Department of Western Australia’s Syphilis Response Team, to provide an update on syphilis in Australia and practical guidance for general practitioners.

Key Points:

• Changing Epidemiology: They highlight the recent increase in syphilis, with cases now extending beyond traditional higher-risk groups. All sexually active patients may be at risk, making ongoing awareness in general practice essential.
• Clinical Presentation: The primary, secondary, latent, and tertiary stages of syphilis, noting the diverse and often atypical presentations. Classic signs such as ulcers and rashes may vary, and neurological symptoms can occur at any stage.
• Screening and Testing: GPs are reminded to include syphilis serology in routine STI screening and to swab any ulcer for syphilis PCR (using a dry swab and requesting “syphilis PCR” on the form). Pregnant people require syphilis screening in early and late pregnancy, and higher-risk groups need more frequent testing.
• Serology Interpretation and Treatment: The use of treponemal and non-treponemal tests. Benzathine benzylpenicillin is the recommended treatment. Empirical treatment of contacts, especially for hard-to-reach patients, is encouraged.
• Further Resources and Support: GPs are advised to access national guidelines and decision-making aids for detailed management and to consult public health units as required.

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