Understanding the continuum of care for pregnant people with infectious syphilis in Australia, 2015-2024 — The Association Specialists
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  3. Understanding the continuum of care for pregnant people with infectious syphilis in Australia, 2015-2024

Understanding the continuum of care for pregnant people with infectious syphilis in Australia, 2015-2024 (24209)

Laila Khawar 1 , Richard T Gray 1 , Amy Bright 2 , Stephanie Bond 3 , Belinda Hengel 1 , Rebecca Guy 1 , Skye McGregor 1
  1. The Kirby Institute, UNSW Sydney, Kensington, NSW, Australia
  2. Communicable Diseases Epidemiology and Surveillance Section, Australian Centre for Disease Control , Canberra , ACT, Australia
  3. Melbourne Sexual Health Centre, Melbourne, VIC, Australia

Background: Congenital syphilis cases doubled in Australia between 2015-2024, amid an ongoing infectious syphilis outbreak. Cascade of care models are increasingly used in public health surveillance to identify gaps across testing, treatment and follow-up; however, their usefulness depends on the completeness and quality of routine data systems. We applied a national cascade of care framework to assess gaps in antenatal syphilis care and highlight data system limitations.

 

Methods: In consultation with the National Cascade Reference Group, we analysed deidentified enhanced national notification data from seven Australian jurisdictions’ health departments (2015-2024) to estimate: (i) total pregnant people with infectious syphilis; (ii) diagnosis timing; (iii) treatment as per national guidelines; (iv) serological follow-up within one year of treatment; and (v) a four-fold reduction in RPR ≥30 days prior to delivery (or 80-100 days from baseline if delivery date unknown).

 

Results: An estimated 996 pregnant people had infectious syphilis during 2015-2024; of these, 935 (93.9%) were diagnosed. Most were diagnosed in the first/second trimesters (n=643, 68.8%), 103 (11.0%) and 46 (4.9%) had a third-trimester and late diagnosis (at/post birth), respectively, and diagnosis timing was unknown for 143 (15%). After excluding late diagnoses, 670 (75.3%) received correct treatment; of these, 239, (35.6%) could be confirmed to have received timely treatment. For 130 (14.6%) treatment was unknown, and 89 (10.0%) received incorrect/late treatment. After excluding those with incorrect/late treatment, 469 (58.6%), had at least one recorded follow-up within one year. Of these, 234 (49.8%) had documented serological assessments, and 96 (20.4%) achieved a four-fold decrease in RPR at ≥30 days prior to delivery or 80-100 days from baseline.

 

Conclusion: Although most pregnant people are estimated to be diagnosed, incomplete treatment and follow-up data constrained surveillance and evaluation. Strengthening robust integrated data systems is essential to optimise cascade monitoring and improve prevention strategies for congenital syphilis.