Syphilis up 167% in Australian women: what GPs need to act on now

Forty infants. That is the number of Australian babies who have died from congenital syphilis since 2016.

This week, data presented at the 2026 Australasian HIV & AIDS and Sexual and Reproductive Health Conference in Melbourne confirmed what clinicians in high-prevalence regions have been seeing for years: syphilis is not a disease of the past, and it is not staying in the groups it once predominantly affected. Syphilis notifications in Australian women have risen 167% over the last decade. In men, the rise was 39%. The gap between those two numbers tells a story about who is now in the path of this outbreak.

The same dataset documented 14 congenital syphilis cases in 2025 alone. These are preventable deaths. Syphilis crosses the placenta. Penicillin treats it effectively. Every congenital case that reaches a bad outcome represents a diagnosis that was not made in time.

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The numbers in context

Australia recorded 5,896 syphilis notifications in 2025, up from 14.3 per 100,000 population in 2016 to 22.3 per 100,000 — a rise of more than 50% across the whole population. Gonorrhoea rose similarly, also by more than 50% over the decade (from 101.2 to 158.6 per 100,000). Chlamydia, by contrast, has declined — from 399.6 to 353.4 per 100,000 — likely reflecting increased testing and treatment and, in some communities, the protective effect of doxycycline post-exposure prophylaxis.

The doxycycline PEP story is actually encouraging and worth knowing. Among gay and bisexual men who took doxycycline within 72 hours of potential STI exposure, syphilis notifications fell 30–37% and chlamydia notifications fell 26–31%. Gonorrhoea remained stable in that group. This is real-world evidence that post-exposure prevention works in the right context — and it is a conversation that belongs in general practice for the right patients.

The harder conversation is about who does not have access to that kind of prevention, testing infrastructure, and follow-up. First Nations Australians are diagnosed with syphilis at six times the rate of non-Indigenous Australians. The same disparity holds for gonorrhoea (4×) and chlamydia (2.5×). Dr Skye McGregor from the Kirby Institute described the gap plainly: “testing and treatment need accessibility.” That is both a systemic challenge and a clinical one — and general practice sits at the intersection.

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Both sides of this story

The case for urgency is clear: the trajectory in women is steep, the consequences are severe, and the deaths from congenital syphilis are preventable. The case for proportionality is also real. Syphilis notifications at the population level, even at 22.3 per 100,000, remain far below chlamydia. The burden is concentrated — geographically in northern and remote regions, and demographically in specific communities — rather than uniformly distributed across the country.

This matters for how general practice responds. A GP in metropolitan Sydney or Melbourne will see far fewer syphilis presentations than a GP in the Northern Territory or western Queensland. Context-specific testing protocols exist for a reason. But the concentrations of risk should not become a reason to stop asking the question outside those settings. Syphilis is also circulating in urban populations — particularly among women who do not identify with the traditional risk categories in STI literature. The woman with an STI in a non-urban general practice is not a statistical anomaly. She is probably not rare enough to skip the conversation.

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2 cents this week

Audit your antenatal screening workflow. The minimum standard is three syphilis tests in every pregnancy — first visit, 26–28 weeks, and 36 weeks. If your practice’s antenatal template does not automate this, it is worth a manual review. The test is inexpensive, the treatment is effective, and the cost of a missed case is catastrophic.

Know your point-of-care options. Where point-of-care syphilis testing is available — and it increasingly is in many Australian general practices — using it changes the treatment window dramatically. A patient you diagnose and treat in the same consultation is a patient who does not go on to transmit. For remote and rural practices especially, this is a meaningful difference.

Consider doxycycline PEP for the right patients. This is a conversation for patients at sustained elevated risk — not a one-off exposure. But for a sexually active patient with recurrent STI presentations or ongoing high-risk exposure, the evidence for doxycycline PEP reducing syphilis and chlamydia transmission is now strong enough to be part of clinical discussions. Your state or territory sexual health service is the right referral pathway if you want support with this.

The forty infant deaths are not an abstraction. Every one of them had a pregnancy that passed through the healthcare system at some point. General practice is where antenatal care often begins, and where the screening that could have caught the diagnosis was either done or not done.

Verdict: yes — review your antenatal syphilis testing protocol this week.

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Sources cited

1. Chlamydia rates decline, but syphilis and gonorrhoea are trending up — The Medical Republic, 21 September 2026
2. Kirby Institute, UNSW Sydney — sexual health research and surveillance