27/11/2025
Syphilis rates have been sky high in Australia for the past couple of years.
Doing an STI test? add syphilis and pregnant women should currently be screened at least 3 times in pregnancy. Prompt treatment can prevent congenital syphilis!
Syphilis Is Back — And It’s Hurting the People We Fail First
Grab a drink, settle in, and let’s talk about a disease most Australians think vanished sometime between the Eureka Stockade and the invention of Vegemite — because syphilis is back, it’s deadly, and the people who cop the worst of it are the same people our health system keeps letting down.
Earlier this month, national peak bodies met online with Chief Medical Officer Professor Michael Kidd AO and Chief Nursing and Midwifery Officer Adjunct Professor Alison McMillan PSM. The message was blunt: syphilis has been declared a Communicable Disease Incident of National Significance (CDINS). That’s Canberra-speak for this is serious, this is national, and this needs to be fixed yesterday.
The numbers are grim enough to make even the most seasoned nurse pause mid-mouthful:
6,566 infectious syphilis cases in 2023
5,968 in 2024
3,546 cases already by August 2025
And most distressing: 99 cases of congenital syphilis since 2016, including 33 infant deaths. Over half of these babies were Indigenous.
These aren’t just numbers — they’re warnings, flashing red lights on a dashboard we’ve ignored for too long.
The Perfect Storm Behind the Outbreak
Syphilis is entirely preventable and entirely treatable. Yet the Queensland Clinical Guideline makes it painfully clear why it keeps slipping through our fingers
It often has no symptoms, meaning people don’t know they’re infected.
It crosses the placenta from as early as 9–10 weeks, leading to miscarriage, stillbirth, liver damage, bone abnormalities, hydrops, and devastating long-term complications in infants.
Early testing and prompt treatment can almost completely prevent congenital syphilis, but only if people can access services.
Aboriginal and Torres Strait Islander communities face notification rates seven times higher than non-Indigenous Australians — not because of “behaviour,” but because of poverty, stigma, distance, racism, and health systems that too often fail to show up for them.
As the file notes, congenital syphilis overwhelmingly affects people dealing with complex social determinants: poverty, unsafe housing, domestic violence, incarceration, limited access to care, and intergenerational trauma.
And here’s the bit politicians never want to say out loud: when health systems crack, they crack along the same old fault lines — and the same communities fall through.
What the CDINS Declaration Actually Does
The declaration activates enhanced national coordination and accelerates the National Syphilis Response Plan (2023–2030). In normal language, that means:
More testing — especially for pregnant women at 10 weeks, 26–28 weeks, and 36 weeks.
Earlier detection.
Better follow-up.
Faster treatment access, particularly in rural and remote services.
A renewed push to prevent congenital syphilis, because every single case is a system failure.
And crucially, it reinforces a message nurses have been shouting for years: short-term, fly-in-fly-out staffing models in remote Australia put communities at risk.
If we’re serious about stopping congenital syphilis, every clinician heading into remote practice must walk in prepared — clinically, culturally, and ethically.
CRANAplus is taking this seriously: embedding the outbreak into education programs, consultations, and remote-ready training.
What Clinicians Need to Know — Now
From the Queensland guideline
Universal testing saves lives.
Benzathine benzylpenicillin is the only effective treatment in pregnancy.
Contact tracing matters — and needs culturally safe, trauma-informed delivery.
Congenital syphilis can appear subtle or silent at birth, but most untreated babies show symptoms by 3–8 weeks.
Declining to test? Have a proper conversation about why — with dignity, privacy and culturally safe care at the centre.
Syphilis might be an old disease, but the modern challenge is new: making healthcare genuinely accessible, culturally grounded, and safe enough that people feel able to engage.
Where to From Here?
Over the coming months, you’ll see syphilis messaging woven through national nursing conversations, training, and remote deployments. And honestly? It’s overdue.
This outbreak isn’t about “risky behaviour.” It’s about equity, access, and whether we are willing to deliver healthcare in ways that meet people where they actually are.
As nurses — especially those working remote — we’re part of the solution.
As The Barefoot Nurse likes to say: the work is always bigger than the ward, the clinic, or the shift. This one is national. And it’s ours.
