Pulse ·
Syphilis in women up 167% in a decade: what to do now
Australia's 2025 sexual health data from the Kirby Institute shows syphilis diagnoses in women rose 167% over the past decade, compared to 39% among men. There were 5,986 syphilis cases nationally in 2025, with 14 congenital syphilis cases — infections passed from a pregnant woman to her infant — and 40 infant deaths recorded over the past decade.
National antenatal guidelines now recommend a minimum of three syphilis tests during pregnancy: once early, again at approximately 26–28 weeks, and a third at or near birth. Testing is straightforward and available in general practice; most infections detected in pregnancy are treatable with penicillin.
The number is 14.
Fourteen congenital syphilis cases in 2025 — infections passed from a pregnant woman to her infant, detectable by a blood test, interruptible with penicillin, and still happening at this rate in 2025 Australia.
Over the past decade, 113 Australian infants were born with congenital syphilis. Forty died. Forty-three percent of 2025’s cases were among First Nations infants — six of fourteen babies.
This is not a mystery infection without a solution. It is a known infection with a known test and a known treatment. The question the Kirby Institute’s 2025 sexual health surveillance data forces into focus is not “what is syphilis doing” but “why is the system still not reaching the pregnancies where this is present.”
The woman who attends antenatal care but doesn’t know her syphilis status because it wasn’t checked — or who came late to care, or who didn’t feel safe disclosing a sexual contact, or who lives in a remote community without reliable access to testing — she is at the centre of this data. These numbers are the record of a system that knew the risk and did not consistently close the loop.
Both sides of this
The case for urgency is not complicated. Syphilis diagnoses in women rose 167% over the past decade — compared to a 39% increase among men. Women now represent 22% of Australia’s 5,986 syphilis cases in 2025. Gonorrhoea remains more than 50% higher than a decade ago. First Nations peoples bear a disproportionate burden: syphilis rates six times higher, gonorrhoea four times, chlamydia two and a half times, the Kirby data shows.
There is a tension to hold here. The epidemiological picture — a disease spreading fastest in communities with the most barriers to care — is not primarily a clinical failure. It is a structural and funding failure. Robert Monaghan, quoted in the Kirby Institute’s release, speaks to the need for sustained investment in services designed with First Nations communities, not for them. That framing matters. Outreach that is not culturally safe is not outreach; it is a missed opportunity wearing the uniform of care.
The optimistic reading of this week’s publication is that it lands in a policy environment that has more architecture for response than it did five years ago. The Australian Centre for Disease Control was established in 2023 partly to provide the centralised surveillance capacity that sexual health outcomes require. The 2025 data is an accountability document as much as it is an epidemiological one.
What it does not do is change what needs to happen in the consulting room today.
What this means in general practice this week
National antenatal guidelines now recommend a minimum of three syphilis tests during pregnancy: once early in pregnancy, again at approximately 26–28 weeks, and a third test at or near birth. For most antenatal patients this should already be standard. For anyone who has presented late, who has had a change in sexual contact history mid-pregnancy, or who comes from a community with elevated prevalence, the clinical threshold for testing should be low.
Australian STI Management Guidelines flag an “urgent low threshold for testing” for women of reproductive age given current epidemiology, and state plainly: a syphilis diagnosis in pregnancy warrants urgent specialist advice and active recall for treatment. Partners should also be tested and, where there is epidemiological exposure risk, presumptively treated.
A few practical points worth naming:
Syphilis is mostly asymptomatic. The primary ulcer heals on its own. By the time a woman presents for antenatal care, she may have had and resolved a primary lesion without knowing what it was. Testing cannot wait for symptoms to appear — they often never do.
A result missed in the first trimester is not a closed question. If you do not have a first-trimester syphilis serology result for an antenatal patient, the answer is to get one now — regardless of gestational age.
The 43% First Nations figure is not a reason to single out patients. It is a reason to ensure that testing is universal, that culturally safe explanations are given, and that follow-up systems are robust for all patients, with additional active support for those who face structural barriers to care.
Untreated syphilis during pregnancy risks miscarriage, stillbirth, and an infant born with a serious infection that can cause lasting organ damage and death. The clinical evidence for systematic testing is unambiguous; the question at the population level is whether the infrastructure around testing is adequate and equitable.
Verdict: yes — this data changes the urgency of the testing conversation now.
Forty infant deaths over a decade. The standard three-test protocol prevents these. What remains is making sure it actually reaches every pregnancy.
Sources cited
Frequently asked questions
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When should syphilis be tested during pregnancy?
National antenatal guidelines recommend at least three tests: once early in pregnancy, again at around 26–28 weeks, and a third at or close to birth. Your GP or midwife can arrange these as part of routine antenatal screening.
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What are the symptoms of syphilis?
Often none. Primary syphilis causes a painless sore or ulcer that heals without treatment, allowing the infection to progress silently through secondary and latent stages. Testing is the only reliable way to detect it, which is why screening during pregnancy matters even without symptoms.