16th December 2016, Volume 129 Number 1447

Sunita Azariah

Syphilis is a serious bacterial infection that can cause significant complications if undiagnosed and untreated.1 Syphilis is usually sexually transmitted but can also be transmitted to the foetus or neonate…

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One hundred and fifty-two cases of infectious syphilis were managed by the Auckland Regional Sexual Health Service in 2015, which is the largest number reported in recent decades. The majority of cases were diagnosed in gay or bisexual men but cases in heterosexuals have also increased significantly. Syphilis is a serious infection that may cause complication such as damage to the nervous system or miscarriage or still-birth if a woman is infected during pregnancy. As syphilis often does not cause symptoms it is recommended that tests for syphilis should always be included when screening people for sexually transmitted infections. Control of this syphilis outbreak requires provision of resource for a dedicated public health response, including regular screening of those at risk, timely treatment to reduce onward transmission, rigorous contact tracing and close follow-up of treated individuals to check for possible re-infection.



To briefly report on the large increase in cases of syphilis managed at Auckland Regional Sexual Health Service (ARSHS) in 2015. To raise awareness of syphilis as an emerging significant public health issue in Auckland.


A search was conducted of the electronic patient management system at ARSHS for cases of syphilis diagnosed between 1st of January 2015 and 31st of December 2015. Those that fitted the Institute of Environmental Science and Research Ltd (ESR) case definitions for infectious syphilis were included and demographic, clinical and behavioural characteristics were described.


One hundred and fifty-two cases of infectious syphilis were managed at ARSHS in 2015, which was a 78% increase from the previous year. The crude incidence rate was 9.5 cases per 100,000 head of population. As in previous years, the majority of cases were male (92%) and most of these were gay or bisexual men (GBM). Thirty-nine percent of cases were asymptomatic and 22% of cases were diagnosed with another STI. Twenty-eight percent of GBM were co-infected with HIV. While the overall number of heterosexual cases was small (n=35); there was a 3.8-fold increase from the numbers diagnosed in 2014 (n=9).


The largest number of syphilis cases in recent decades was managed by the Auckland Regional Sexual Health Service in 2015. The increase in numbers is concerning as syphilis can enhance transmission and acquisition of HIV. Furthermore, other countries have noted increases in congenital syphilis cases when incidence in females has increased. It is important that all persons at risk of STI are tested for syphilis and that sexually active GBM in particular are tested regularly. Health professionals need to be made aware of who and when to test, and to refer or discuss any suspected cases with a specialist service as management of syphilis requires significant expertise.

Author Information

Sunita Azariah, Sexual Health Physician, Auckland Regional Sexual Health Service, Auckland District Health Board, Auckland.


Sunita Azariah, Sexual Health Physician, Auckland Regional Sexual Health Service, Building 7, Greenlane Clinical Centre, Auckland 1142.

Correspondence Email


Competing Interests



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