Syphilis CDNA National Guidelines for Public Health Units Revision history Version Date Revised by Changes 1.0 June 2015 Original 1.1 June 2018 Public Health Document further updated for Laboratory currency and revised formatting. Network, STI Enhanced Additional information provided Response Unit, for: Multijurisdictional - syphilis point of care testing outbreak working (Page 15 of the SoNG and pp. group (MJSO) 43-45 of Appendix D) - frequency of testing during pregnancy within the context of an outbreak (page 18 and 25) The Series of National Guidelines (‘the Guidelines’) have been developed by the Communicable Diseases Network Australia (CDNA) and noted by the Australian Health Protection Principal Committee (AHPPC). Their purpose is to provide nationally consistent guidance to Australia’s public health units (PHUs) in responding to a notifiable disease event. These guidelines capture the knowledge of experienced professionals, and provide guidance on best practice based upon the best available evidence at the time of completion. Readers should not rely solely on the information contained within these guidelines. Guideline information is not intended to be a substitute for advice from other relevant sources including, but not limited to, the advice from a health professional. Clinical judgement and discretion may be required in the interpretation and application of these guidelines. The membership of CDNA and AHPPC, and the Commonwealth of Australia as represented by the Department of Health (Health), do not warrant or represent that the information contained in the Guidelines is accurate, current or complete. CDNA, AHPPC and Health do not accept any legal liability or responsibility for any loss, damages, costs or expenses incurred by the use of, or reliance on, or interpretation of, the information contained in the guidelines. Endorsed by CDNA: 17 July 2018 Noted by AHPPC: 01 August 2018 Released by Health: 03 August 2018 Contents 1. Summary ...............................................................................................................................................4 Public health priority .................................................................................................................................4 Case management ....................................................................................................................................4 Contact management ...............................................................................................................................5 2. The disease ...........................................................................................................................................5 Infectious agents .......................................................................................................................................5 Reservoir ...................................................................................................................................................5 Mode of transmission ...............................................................................................................................5 Incubation period......................................................................................................................................5 Infectious period .......................................................................................................................................5 Clinical presentation and outcome ...........................................................................................................6 Persons at increased risk of disease..........................................................................................................6 Disease occurrence and public health significance ...................................................................................7 3. Routine prevention activities ................................................................................................................7 4. Surveillance objectives ..........................................................................................................................7 5. Data management ................................................................................................................................7 6. Communications ...................................................................................................................................8 7. Case definition ......................................................................................................................................8 Infectious Syphilis – less than two years duration (includes primary, secondary and early latent including reinfections) ..............................................................................................................................8 Syphilis - Congenital ..................................................................................................................................9 Syphilis - more than 2 years or unknown duration ................................................................................ 11 8. Laboratory testing ............................................................................................................................. 12 Syphilis serology ..................................................................................................................................... 12 Treponemal specific tests ...................................................................................................................... 12 Non-treponemal tests ............................................................................................................................ 13 Reporting and interpretation of tests .................................................................................................... 13 Nucleic acid amplification techniques.................................................................................................... 14 Point of care tests for syphilis ................................................................................................................ 14 9. Case management ............................................................................................................................. 15 Response times ...................................................................................................................................... 15 Investigation .......................................................................................................................................... 15 Case investigation .................................................................................................................................. 15 Case treatment ...................................................................................................................................... 16 Monitoring response to treatment ........................................................................................................ 17 Syphilis in pregnancy .............................................................................................................................. 17 Education ............................................................................................................................................... 18 Page 2 of 45 Isolation and restriction ......................................................................................................................... 18 Active case finding ................................................................................................................................. 18 10. Environmental evaluation .............................................................................................................. 19 11. Contact management .................................................................................................................... 19 Identification of contacts ....................................................................................................................... 19 Contact definition .................................................................................................................................. 19 Contact management ............................................................................................................................ 19 Response times ...................................................................................................................................... 20 Empirical treatment ............................................................................................................................... 20 Education ............................................................................................................................................... 20 Isolation and restriction ......................................................................................................................... 20 12. Special situations ........................................................................................................................... 20 13. References and additional sources of information ........................................................................ 21 14. Appendices .................................................................................................................................... 23 Appendix A. Syphilis fact sheet .............................................................................................................