Testing and capturing difficult-to-access populations for syphilis control in Australia

Abstract

Syphilis has significantly increased in the past decade in Australia, particularly among gay, bisexual and other men who have sex with men in urban areas, and Aboriginal and Torres Strait Islander peoples in regional and remote areas. Additionally, there has been a rise in cases among heterosexual men and women, including pregnant women, leading to a re-emergence of congenital syphilis. This resurgence underscores the ongoing need for effective public health interventions and innovative screening and detection methods. This article explores the epidemiology, screening and detection methods for syphilis, particularly focusing on difficult-to-access populations. Current screening strategies, including serology and molecular assays and recent changes in antenatal screening guidelines to prevent congenital syphilis are discussed. The article highlights the need for innovative, patient-centred detection methods and tailored interventions. New early detection methods, such as improved rapid diagnostic tests and digital health solutions, are discussed for their potential to increase screening uptake and early diagnosis. The findings underscore the importance of a multidisciplinary approach in syphilis control, combining universal and targeted interventions to effectively reduce transmission and improve public health outcomes.