ESR reports major bump in syphilis cases in 2023

Infectious syphilis case numbers rose by an alarming 45% in Aotearoa, New Zealand last year from 508 to 736 cases. The 2023 case numbers are the highest number ever recorded in the annual Sexually Transmitted Infections (STI) surveillance reports by the Institute of Environmental Science and Research (ESR). Syphilis case numbers have almost doubled for gay and bisexual men but diagnoses in women of reproductive age have also been rising steadily in recent years. This can have tragic consequences if a woman acquires syphilis in pregnancy.

As with other STIs, there are stark inequities for syphilis with rates for Māori and Pacific Peoples twice that of other ethnicities. The three cases of congenital syphilis last year were all in Māori babies.

“Syphilis is a devastating infection in pregnancy,” said Dr Jeannie Oliphant, President of the New Zealand Sexual Health Society, “with around 40% of infected babies still born or dying soon after birth.”

36% of the women who were diagnosed last year were pregnant. “Given that approximately only 5% of women in the reproductive age group are pregnant at any given time, this suggests there is a lot of undiagnosed syphilis,” said Oliphant. “There is an urgent need to increase testing in the community.”

“Syphilis will continue to spread unless we can increase testing to identify infections early, then provide treatment for cases and their sexual contacts to prevent onward transmission,” said Oliphant, “Syphilis is efficiently transmitted, is often unrecognised and already has a firm foothold,” she said. “This situation requires an urgent response and will need appropriate resourcing to prevent numbers continuing to increase.”

Immediate actions to control syphilis in heterosexuals include syphilis screening during antenatal care, coupled with contact tracing to diagnose and treat infected partners. For gay and bisexual men, those at heightened risk can be offered “doxy-PEP”, a prescription of post-exposure doxycycline prophylaxis. All sexual health care should be respectful, relevant for the individual’s needs and non-stigmatising.

Note

• Syphilis is spread by close sexual contact
• Syphilis is easily treatable but needs to be diagnosed on a blood test
• While some people will develop an ulcer or a rash, many people do not have symptoms