Congenital syphilis: 33 babies dead, 91 cases — a systemic failure

What just happened

The numbers are stark. Between 2020 and 2025, 91 babies in Australia were born with congenital syphilis. Thirty-three of them died.

This is not a disease of another era. It is happening here, in 2026, to babies whose mothers were pregnant in the same years Australia was navigating COVID vaccination programs and debating bulk-billing policy. Congenital syphilis is almost entirely preventable: a pregnant woman with syphilis, detected early and treated appropriately, does not pass the infection to her baby. The cases that occurred represent failures of detection, treatment access, and continuity of care — layered, systemic, and now formally documented.

In August 2025, syphilis was declared a Communicable Disease Incident of National Significance by the Australian Centre for Disease Control. A national roundtable convened by NACCHO and ASHM in March 2026 produced the clearest accounting yet of where things went wrong — and eight priority areas that need urgent action.

Both-and

What the roundtable named

The most urgent failure is medicine supply. Benzathine benzylpenicillin-G is the only recommended treatment for syphilis in pregnancy that reliably crosses the placenta in concentrations sufficient to protect the baby. It has faced recurrent shortages across Australia, and those shortages are forecast to continue through November 2027. A GP who diagnoses syphilis in a pregnant woman and cannot access this one drug is not in a position to prevent transmission. The shortage is not a logistical footnote — it is an active, ongoing contributor to preventable cases.

The second cluster of failures involves antenatal testing protocols. Current guidelines recommend syphilis screening for all pregnant women at their first antenatal visit, with repeat testing in the second trimester and at delivery for women in high-prevalence areas or with ongoing risk. But the roundtable found that some facilities were still operating with outdated protocols, and that healthcare workers — including GPs — were not uniformly aware of the updated standards. The gap between what the guidelines say and what is implemented at the clinical interface is where preventable transmission accumulates.

Data gaps compound both of these problems. Significant deficiencies in tracking infant testing outcomes mean the actual burden of congenital syphilis is likely underestimated. Australia does not have a reliable picture of how many babies born to seropositive mothers were tested, treated, and followed up appropriately. Without that data, it is difficult to evaluate whether interventions are working.

The geographic and social dimensions of the outbreak are impossible to separate from the clinical ones. Aboriginal and Torres Strait Islander women face syphilis notification rates approximately seven times higher than non-Indigenous Australians. The roundtable identified geographic remoteness, stigma, substance use, homelessness, and domestic violence as layered access barriers. Community-led models through Aboriginal Community Controlled Health Organisations are part of the response, but they require expansion and sustained federal funding — neither of which has been fully committed.

What is contested

The framing of “systemic failure” is accurate, but it requires some precision to be useful rather than just blaming. Individual clinicians — GPs, midwives, obstetricians — working in a system with drug shortages, outdated protocols, and insufficient workforce were not failing personally. The failure is structural. Locating accountability at the policy and resourcing level rather than the bedside is the point of the roundtable’s framing.

The genuinely contested question is whether the syphilis response plan now in train is adequately resourced. Workforce constraints were identified in the first national roundtable in 2024. Two years later, they remain largely unresolved. Additional Medicare items for GPs, expanded treatment scope, and embedded training in professional development have been proposed. Whether they receive funding and reach implementation at the scale needed is an open question that the roundtable’s recommendations alone cannot answer.

There is also a question about whether the national data system is adequate to evaluate progress. Without consistent tracking of maternal testing rates, treatment uptake, and infant outcomes at the jurisdictional level, the next roundtable in two years’ time may be working from the same data gaps. Improving the measurement infrastructure is a prerequisite for knowing whether the interventions are working.

Why this matters for anyone who is pregnant or planning to be

Congenital syphilis sits in a category of clinical problems where the patient-level action and the system-level action are quite different. At the individual level, the message is direct: syphilis is routinely screened for in the first antenatal bloods. If you are pregnant, it has almost certainly already been done. If you are not sure, ask. If you are planning a pregnancy, know that it will be offered.

The drug shortage is not something any individual patient can fix. The procurement failure is federal. But knowing that the shortage exists — and asking your GP what the current local supply situation is if you are diagnosed — is not unreasonable.

My two cents

If you are pregnant: syphilis testing at the first antenatal visit is standard. If you are in a regional or remote area, or identify as Aboriginal or Torres Strait Islander, ask specifically whether you will be retested in the second trimester. You are entitled to that.

If you are a GP with pregnant patients: the current Australian guidelines are the ones to apply — first visit, and again at 26–28 weeks and at delivery for high-risk or high-prevalence populations. The medicine supply situation is worth verifying locally ahead of any positive diagnosis, given the documented shortages.

Thirty-three deaths in five years is not an acceptable baseline for a preventable infection. The roundtable has named what needs to change. Whether the system responds at the scale and speed the data demands is the question that the next five years will answer.

Verdict: yes — this is clinically important for anyone involved in pregnancy care, and worth knowing about as a patient in a system that is documented to have failed at basic prevention.

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Sources cited

1. Congenital syphilis a ‘systemic failure’. Medical Republic, 12 August 2026. https://www.medicalrepublic.com.au/congenital-syphilis-a-systemic-failure/128141
2. ASHM syphilis response resources. Australasian Society for HIV, Viral Hepatitis and Sexual Health Medicine. https://www.ashm.org.au/syphilis/
3. Syphilis response. Australian Government Department of Health and Aged Care. https://www.health.gov.au/topics/communicable-diseases/syphilis