SYPHILIS

9-90 days (mean 30) to primary syphilis;

30-150 days to secondary syphilis;

early latent presents post-secondary syphilis less than 2 years post last negative test; late latent presents more than 2 years post last negative test;

5-35 years to tertiary syphilis.

According to sexual history and clinical stage of infection:

• Primary syphilis — 3 months plus duration of symptoms or last negative test;
• Secondary syphilis — 6 months plus duration of symptoms or last negative test;
• Early latent syphilis — 12 months or most recent negative test
• Late latent/tertiary syphilis: Test current partner/s. If any doubt as to whether the patient has early latent or late latent syphilis, contact trace as for early latent syphilis.

If the stage of syphilis is unclear, contact your local specialist service for advice

Anogenital or oral ulcers

Rash

Early infection commonly asymptomatic

Likelihood of transmission per act of unprotected intercourse

Early syphilis (primary, secondary, early latent): >20 %

Late latent and tertiary: usually not infectious

Up to 50% if early syphilis;

<1% if no contact during infectious period

Congenital infections in pregnancy

Neurosyphilis, cardiovascular syphilis, enhanced HIV transmission 

Ensure window period follow-up testing occurs where the person is not offered presumptive treatment, is pregnant or intending to become pregnant, or is the sexual partner of a pregnant person. This will decrease the risk of a missed diagnosis, reinfection and/or congenital syphilis.

Seek specialist advice if there is a concern for older children of a person newly diagnosed with syphilis during pregnancy.

Consultation with sexual health physician in all cases is suggested

1. Presumptively treat all sexual contacts of patients with primary or secondary syphilis regardless of serology. Ensure additional serology such as (HIV, syphilis, Hepatitis A, B and C) is collected as appropriate, plus a screen for chlamydia and gonorrhoea. Informed consent must be obtained before testing or treating.
2. Contacts of early latent syphilis can also be treated

   presumptively, but if the contact was greater than 3 months previous, treatment delayed until serology is available and then given according to serology result. If the exposure was greater than 12 months ago and the patient has positive serology, treat as for late infection.

3. If the contact is penicillin allergic [1] or needle-phobic check the STI Guidelines for alternative treatment or discuss treatment options with your local specialist service. If obtaining benzathine penicillin is difficult, do not substitute with a different treatment and consult with your local specialist service.
   

Notifiable by doctors in all Australian states and territories, and in New Zealand; as well as laboratories in some Australian states and territories

Where a syphilis register exists in your State, Territory or region, ensure you promptly report the required details. Where there are any concerns or ambiguity contact your local public health service for additional support.