By Anna Murray
Syphilis is on the rise in Tāmaki Makaurau - but it seems many people aren’t sure what this serious disease even is.
Syphilis cases were once rare to find, but there’s been a big increase in the number of reported cases in Auckland over the past seven years.
There has been a particularly sharp uptick in Auckland’s number of cases between 2021 and 2022, with a 50% increase in people with confirmed syphilis.
There’s also been a shift in the demographics of Aucklanders testing positive for syphilis.
Māori made up 32% of the cases reported in 2022, jumping up from 14% in 2020, while Pacific people moved from being 12% of cases in 2020 to 16% of cases in 2022.
More women are testing positive for the disease, too. Nationally, the number of women aged 15-44 with syphilis were at their highest ever reported level in 2022, with 40% of those detected in pregnancy.
So, what is syphilis?
Syphilis is a sexually transmitted infection.
It’s a bacteria that can spread through the body’s bloodstream and can cause some people to become really unwell.
It can be easily treated with antibiotics.
But if left untreated, some people can get late stage syphilis years after their original infection, which can damage their brain, heart, nerves, liver, blood vessels and bones.
Pregnant people can also pass syphilis to their baby through the placenta if they’re infected with the disease.
Without treatment, there’s a high risk that the pregnancy will end in miscarriage, stillbirth or the baby will be born with congenital syphilis or die soon after birth.
That’s why testing for syphilis is part of the antenatal testing for all pregnant people.
In Auckland, health providers have started testing people for a second time in their pregnancy in case they catch syphilis later.
Between 2016 and 2022, there were 31 cases of congenital syphilis in New Zealand.
Why is Auckland seeing a wave of syphilis?
The reasons for Auckland’s rise in syphilis case numbers aren’t clear, says Te Whatu Ora Service Clinical Director - Sexual Health, Jeannie Oliphant.
“We do know that people weren’t accessing health services in the usual way over the Covid-19 period and were testing less often for sexually transmitted infections,” she says.
“So, it’s likely that people still had syphilis but just weren’t coming to Auckland Sexual Health or their primary health care teams to be tested.”
Oliphant says unlike Covid-19, where you might be infectious for one or two weeks if you sneeze and cough near others, people with syphilis can be infectious for up to two years and can pass this on to new sexual partners.
“While lockdowns helped prevent the spread of Covid-19, they didn’t prevent the spread of syphilis.”
Many people don’t know they have syphilis
Oliphant says syphilis is a serious infection and doesn’t go away without treatment.
“However, around half the people we see with syphilis have no symptoms at all and wouldn’t know they had it without getting a blood test to check,” she says.
If left untreated, a third of people will develop long-term health problems.
“Before the invention of penicillin, syphilis was a common cause of blindness, dementia, and many other health problems,” Oliphant says.
“The good news is that syphilis is easy to treat with penicillin injections and, once treated, the infection is gone and won’t cause ongoing problems.
“However, it can be caught again so it’s important to repeat your sexual health tests if you have a new sexual partner.”
A lot of people also don’t know what syphilis is
“Our biggest challenge is that people don’t know about syphilis,” Oliphant says.
“The most common thing people say to the syphilis contact tracing nurses is, ‘Syphilis? What’s that?’”
Oliphant says if people don’t know about syphilis - and don’t know that cases are rising - they also don’t know to go and ask for a blood test for it.
“People can also feel whakamā or embarrassed about accessing sexual health tests,” she says.
“This makes rolling out testing in the community more challenging as we need to be mindful of where people feel comfortable to have a sexual health test.”
Taking healthcare to the people
While there is some promotional work underway to help educate people about syphilis, Oliphant says there’s still more work to be done.
“Once people know about syphilis, they can take action for their own health,” she says.
“From Covid-19 we also learnt that if you take healthcare to where people are, then they will access that care.
“Providing access to a free syphilis test easily in the community would remove some barriers from testing - [and] the more people we test for syphilis, the more cases we will find.
“Without increasing testing we can’t reduce the impact that syphilis is having in our communities.”
Te Whatu Ora - Health New Zealand published a National Syphilis Action Plan in 2019 to respond to the increase in syphilis cases, says Deborah Woodley, Interim Director, Population Health Programmes Commissioning.
“The action plan focuses on four priority areas: prevention and health promotion, testing and management, antenatal care and surveillance and monitoring,” she says.
“One of the benefits of the current health reforms is to enable a nationalised approach across the country in raising awareness of syphilis as well as ensuring a consistency of care across all communities.
“It shouldn’t matter who you are or where you live, everyone should have equitable access to sexual health services.”
Protecting yourself from syphilis
Condoms can’t always protect you from getting syphilis, Oliphant says.
“You can catch syphilis from having oral sex or even just very close intimate genital skin to skin contact. So, your best protection is to use condoms and have an STI test if you have a new sexual partner or if you have symptoms.”
People with syphilis can develop one or more small ulcers in their mouth, on their genitals or around their bottom.
Oliphant says the ulcers will go away but people may later develop a rash on their body, palms of their hands and soles of their feet.
But many people with syphilis don’t have any symptoms.
This is why sexual health physicians like Oliphant are encouraging everyone who’s sexually active to get tested.
Oliphant says Auckland Sexual Health is working to increase the testing options for syphilis.
People can now request a blood test for syphilis through its website. The service will also test for HIV.
“If your test is positive, the contact tracing team from Auckland Sexual Health will be in touch to arrange treatment and talk to you about getting all your sexual contacts treated as well,” Oliphant says.
She says contact tracing is important for making sure all sexual contacts are also tested and treated.
“This is the most effective way we have of preventing new infections.”
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