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Syphilis is caused by the bacterial spirochete Treponema pallidum. It is transmitted sexually or vertically (from mother to child). Early syphilis is fully treatable with penicillin. Congenital syphilis can be significantly reduced with adequate maternal screening in early pregnancy and treatment , screening for syphilis is part of routine antenatal care in Australia.
Syphilis is a notifiable disease in Australia; rates of syphilis have increased in recent years. Congenital syphilis is uncommon in the Australian population . Limited data suggest syphilis may be slightly more prevalent in recently arrived refugees than in the general population [5, 6], although this varies depending on country or origin . Worldwide syphilis is most common in sub-Saharan Africa, south and southeast Asia, Latin America and the Caribbean.
During pregnancy there is a high risk of vertical transmission in early syphilis (~50% of infants are infected) and a lower risk in late syphilis (~40% in early latency and 10% in late latency) . Congenital syphilis probably follows the same stages of infection as sexually transmitted infection, but manifests differently in infants, who lack adequate immune control. Congenital syphilis may:
In Australia, pregnant women are screened for syphilis (preferably in the first trimester) using a treponemal test. Women will then be offered treatment with penicillin (usually benzathine penicillin, according to the Australian Therapeutic Guidelines) and their RPR titre will be monitored to ensure that is has fallen 4-fold prior to delivery.
Infants born to women with syphilis during pregnancy (regardless of adequacy of treatment) should have screening with:
Treponemal tests may be positive for up to 18 months due to transplacental transfer of IgG; therefore they are not a good indicator of infection in the infant.
Infants born to women who received adequate treatment* during pregnancy, who have a normal examination AND an RPR titre the same or less than 4-fold maternal RPR titre may not require treatment, but should be followed at 3,6 and 12 months with clinical examination and syphilis serology until the RPR is negative.*Adequate treatment = penicillin, more than 4 weeks prior to delivery with treatment confirmed by 4-fold fall in RPR titre)
All other infants should be considered potentially infected and should receive further investigations and treatment for congenital syphilis. A child is considered to have congenital syphilis if either:
Additional investigations in infants with congenital syphilis
Management of infants with congenital syphilis
In the United States, syphilis testing is recommended for all refugees over 15 years AND refugees <15 years who are sexually active or have a history of sexual abuse or with a mother who tests positive for syphilis. It is a visa requirement that persons >15 years applying for either an offshore or onshore protection visa have syphilis testing and treatment if needed. For offshore entrants, this occurs prior to arrival in Australia. In Australia, syphilis screening is not routine for refugee children. In general:
Syphilis is a notifiable disease (Group C condition)
Immigrant health resources. Author: Vanessa Clifford and Georgie Paxton, June 2013. Last review April 2017. Contact: firstname.lastname@example.org