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Syphilis Advice for Maternity Care Providers

Monday 15 September 2025

Statements and Guidelines, Women's Health

Background

Syphilis is caused by the spirochaete bacterium Treponema pallidum (subspecies pallidum). It is typically transmitted through direct contact with infectious lesions or mucous membranes during anal, oral, or vaginal sexual contact, and can also be passed from mother to child at any stage of pregnancy.¹

During pregnancy, syphilis is associated with a high risk of adverse outcomes, including stillbirth, preterm birth, small-for-gestational-age infants, and vertical transmission leading to congenital syphilis. Congenital syphilis can present with serious features such as pneumonia, profuse nasal discharge, enlargement of the liver and spleen (hepatosplenomegaly), swollen lymph nodes (lymphadenopathy), elevated bilirubin levels (hyperbilirubinemia), cholestasis, meningitis, and seizures. Congenital syphilis can cause severe long-term sequelae for infants affected.^2,3

Surveillance and impact in Australia

Syphilis is a notifiable condition in Australia, subject to rigorous national surveillance and monitoring. The Chief Medical Officer declared syphilis a  on 7 August 2025, initiating a coordinated national response focused on expanded testing, community awareness, simplified treatment pathways, health equity, and workforce strengthening – especially in Indigenous and underserved communities.^4,5

As syphilis frequently presents without symptoms, a low threshold for testing is essential. Diagnosis relies on serological testing, though interpretation can be complex and may require specialist input. Early detection and treatment are critical to preventing congenital syphilis and reducing transmission across the population.¹

Congenital syphilis

In 2024, there were 5,960 notifications of infectious syphilis (acquired within the previous two years), including 1,025 cases among women aged 15–44. Between 2013 and 2022, notification rates in women increased nearly six-fold. Since 2019, cases of congenital syphilis have risen. In 2023, there were 20 reported cases in Australia, including 10 infant deaths. Aboriginal and Torres Strait Islander peoples continue to experience disproportionately high rates, more than five times those of non-Indigenous Australians – reflecting entrenched health inequities.^4,5

Untreated maternal syphilis carries significant risks for pregnancy outcomes. The likelihood of fetal infection increases as pregnancy progresses, rising from 26% if treatment is provided by 24 weeks to 60% if delayed until the third trimester. Adverse outcomes include stillbirth (21%), preterm birth (6%), and congenital syphilis presenting as clinical disease in the neonate (16%). Neurological sequelae may also occur, though only the most severe are typically apparent at birth.^2,3

Updated recommendations

The Communicable Diseases Network Australia (CDNA) emphasise that the management of syphilis requires coordinated action between Public Health Units and treating clinicians.

The following best-practice recommendations detail the prevention and management of syphilis during pregnancy:

Universal first screening – Offer and recommend syphilis testing to all pregnant women at their first antenatal contact, regardless of assessed risk.
Universal repeat screening – Repeat screening should be offered at 26–28 weeks and again at either 36 weeks or at birth (whichever comes first), regardless of risk.
Catch-up screening – If earlier opportunities for testing are missed, offer screening at the next available occasion.
Specialist input – For women who test positive, seek urgent advice from a sexual health or infectious diseases expert. Arrange prompt review and referral where appropriate, and ensure planning for neonatal assessment at birth.
High-risk women – For those assessed as at increased risk, recommend testing at five points: the first antenatal visit, 26–28 weeks, 36 weeks, at birth, and again six weeks postpartum.
Early treatment in high-risk women – For individuals assessed at increased risk of syphilis, consider offering treatment promptly based on screening results – without waiting for confirmatory testing – if there is a risk they may not return for follow-up.
Confirmed infectious syphilis – Women with confirmed infectious syphilis should receive 2.4 million units of benzathine penicillin intramuscularly (in 2 divided doses) as soon as possible. Where possible, treatment should be administered at least 30 days before the expected date of birth. Repeat serology is recommended to confirm efficacy of treatment.
Partner and contact management – Ensure partner testing and treatment, and initiate contact tracing. Where needed, seek support from a sexual health service or specialist in contact tracing.

Clinical implications

Maternity care providers play a critical role in preventing congenital syphilis. Consistent, repeated testing regardless of risk and timely treatment are essential, along with effective contact tracing, specialist referral, and neonatal assessment.

Professor Kirsten Black
Chair, RANZCOG Sexual and Reproductive Health Committee

Dr Stephanie Bond
Member, RANZCOG Sexual and Reproductive Health Committee

Further information

Australian Centre for Disease Control.
Australian Department of Health, Disability and Ageing.
Communicable Diseases Network Australia (CDNA).
Living Evidence for Australian Pregnancy and Postnatal Care.
Queensland Health.
Melbourne Sexual Health Centre.

References

Communicable Diseases Network Australia (CDNA). National Guidelines for Public Health Units on Syphilis. Canberra: Australian Government; 2023.
Living Evidence for Australian Pregnancy and Postnatal Care. Australian Pregnancy Care Guidelines. [MagicApp]; 2023. Available from: .
Queensland Health. Queensland Clinical Guidelines: Syphilis in Pregnancy. Brisbane: Queensland Health; 2023.
Australian Centre for Disease Control. National Syphilis Surveillance and Response Plan 2023–2030. Canberra: Australian Government; 2023.
Australian Department of Health, Disability and Ageing. Chief Medical Officer’s Statement: Communicable Disease Incident of National Significance – Syphilis. Canberra: Australian Government; 2025.