Syphilis
Stages and skin signs of syphilis, how it mimics other diseases, reading treponemal and RPR results, ASHM treatment by stage during the Bicillin L-A shortage, neurosyphilis and ocular syphilis, pregnancy and congenital syphilis, follow-up titres and contact tracing.
Tier 2Condition
Written with AI assistance and fact-checked against the sources below. For exam study, not clinical decisions. How notes are made
At a glance
- Syphilis (Treponema pallidum) has returned in Australia. An outbreak among young Aboriginal and Torres Strait Islander people in northern and central Australia has run since 2011, cases rose among GBMSM and heterosexual people in cities, and congenital syphilis has caused infant deaths. It was declared a Communicable Disease Incident of National Significance on 7 August 2025.
- It is the great mimic. Test for it in unexplained rash, uveitis, hearing loss, hepatitis, nephrotic syndrome, aortitis, stroke in the young, dementia or psychosis.
- Diagnosis is serology (treponemal screen, confirmed with TPPA, activity by RPR) plus PCR of lesions.
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Sources
- Australian STI Management Guidelines for Use in Primary Care: syphilisAU/NZASHM (Australasian Society for HIV, Viral Hepatitis and Sexual Health Medicine), Updated 13 October 2026 (Bicillin L-A shortage to 31 March 2027)
- Therapeutic Guidelines: Antibiotic (syphilis, neurosyphilis)AU/NZTherapeutic Guidelines Limited (eTG complete), current eTG edition (topic version not verified)
- Syphilis advice (testing in pregnancy)AU/NZRoyal Australian and New Zealand College of Obstetricians and Gynaecologists, 15 September 2025
- Workowski KA et al. Sexually transmitted infections treatment guidelines, 2021. MMWR Recomm Rep 2021;70(4):1-187US Centers for Disease Control and Prevention, 2021 (still the current CDC edition, November 2026)
- Trubiano JA et al. Development and validation of a penicillin allergy clinical decision rule (PENFAST). JAMA Intern Med 2020;180:745-52JAMA Internal Medicine, 2020
- Last updated
- 14 November 2026
What changed
- 14 November 2026 Personal emails, About story and Australian-style copy