Detection of congenital syphilis in the Northern Territory: a look back at syphilis serology testing in pregnant Aboriginal women to formulate testing recommendations.

BACKGROUND

Congenital syphilis is a preventable disease and a direct reflection of rates of syphilis in the population. Between 2013 and 2022, Australia's infectious syphilis notification rate increased six-fold in women. Between 2013 and 2022, 54% (n = 45) of congenital syphilis cases were reported in Aboriginal infants, and 61% (n = 11) of congenital syphilis-associated deaths between 2016 and 2022 occurred in Aboriginal infants. In 2018, Communicable Diseases Network Australia National Guidelines were updated, recommending syphilis serology testing five times for women during the perinatal period in outbreak areas. The aim of the study was to gain an understanding of the rates of perinatal syphilis serology testing, and to formulate recommendations on how syphilis serology testing can be improved for pregnant Aboriginal women in the Northern Territory.

METHODS

A retrospective audit of antenatal and postpartum episodes of care and syphilis serology testing of Aboriginal women who birthed a live born or stillborn baby was undertaken at four sites including three Northern Territory Health remote clinics and one Aboriginal Community Controlled Health Service. This was an audit of electronic medical records, between 1 May 2019 and 31 March 2021.

RESULTS

The study found that 94% (n = 358) and 93% (n = 357) of Aboriginal women had a first antenatal episode of care and first antenatal syphilis test, respectively. The proportion receiving syphilis serology decreased to a greater extent than the number of women attending antenatal episodes of care with increase in gestational age. Postpartum episodes of care were attended by 27% (n = 103) of Aboriginal women, with 29% (n = 112) having a postpartum syphilis test.

CONCLUSION

Pregnant Aboriginal women are attending for antenatal care; however, the majority are not having syphilis tests as per current guidelines. It is recommended that the primary healthcare sector implement a prompt system for syphilis serology testing, provide more opportunistic syphilis serology testing and monitor adherence to syphilis serology testing guidelines in pregnancy.