Syphilis might sound like a condition from the history books, but it remains a very real public health issue – and one that deserves the attention of every nurse, midwife and care worker.
In August 2025, Australia’s Chief Medical Officer declared syphilis a Communicable Disease Incident of National Significance (CDINS).1 This designation is reserved for situations where a disease poses a national public health risk.
A CDINS triggers strengthened surveillance, closer jurisdictional coordination, targeted public health action and a strong emphasis on workforce awareness.2
For the health workforce, it is a clear call to action.
CDINS declarations are rarely made. Before syphilis, the most recent was for Japanese encephalitis virus in 2022. Syphilis now sits in this select group – not because the condition is new, but because the harms we are seeing are preventable and escalating.
In 2023,2 infectious syphilis notifications reached their highest levels in since reporting began and transmission has remained high. Cases of congenital syphilis have increased, representing one of the most concerning and avoidable consequences of untreated infection.
Who is at risk?
Perhaps the most important shift is who is being affected. Although men account for the majority of infectious syphilis cases, recent reductions have been most evident in this population.2 This is an encouraging sign of what proactive community-led health promotion, routine testing, and early healthcare engagement can achieve.
Infectious syphilis notification rates remain around seven times higher among Aboriginal and Torres Strait Islander peoples than non-Indigenous Australians,2 reinforcing the need for culturally safe responses grounded in community leadership.
Surveillance data also shows increasing infections among women of reproductive age – a key factor driving ongoing cases of congenital syphilis.2
Syphilis affects people of all ages and rates are rising among older people.2 For nurses and care workers in aged care, this highlights the importance of including sexual health as part of holistic, inclusive care across the lifespan.
The implication is simple but critical: syphilis can no longer be thought of as sitting in one corner of the health system. It is appearing in emergency departments, general practice, antenatal care, aged care and mental health – sometimes without obvious clues.
A quick clinical refresher
Syphilis is caused by the bacterium Treponema pallidum.3 It usually spreads through direct sexual contact with infectious lesions and can be transmitted vertically during pregnancy. It progresses through stages when untreated: primary, secondary, latent and tertiary. Presentations are highly variable.
Early infection may involve a painless ulcer.3 Secondary disease can present with lesions in places you might expect (like the genitals), rashes in places you might not (such as the hands or trunk) or vague systemic symptoms. Latent infection has no symptoms at all, while late disease can involve neurological or cardiovascular complications. Many infections are detected without obvious symptoms; cases may be unaware, untreated, and at risk of unknowingly passing infection on so regular asymptomatic screening is important.
There is no vaccine, but syphilis is easily diagnosed and effectively treated when clinicians think to test.
What this means for your practice
For healthcare workers in all settings, this means staying open to a broader range of explanations for someone’s symptoms. Unexplained rashes, neurological symptoms, ulcers, or unexplained systemic illness should prompt consideration of syphilis – even when patients don’t match our assumptions about who it affects.
You do not need to be a sexual health expert to discuss syphilis risk or testing. Nurses and midwives are experts in creating safe, respectful spaces for the people we care for. Inclusive language, openness, and a non-judgemental approach are skills we use every day.
Sexual health is a normal part of life, and a sexual history should be part of any comprehensive assessment. Using matter-of-fact language such as “I ask everyone these questions” can reduce discomfort. If we treat these conversations as routine, they will start to feel routine, both for us and the people we care for.
Sexual health needs do not disappear as we age; inclusive conversations and offering information remain important in supporting earlier diagnosis for older Australians.
A workforce call to action
The national response identifies nurses, midwives and care workers as central to reversing current trends. The brief: think syphilis more often, test early (repeating as often as needed) and talk openly about sexual health.
Further resources are available through the Australian Centre for Disease Control website.
References
1 Australian Government Department of Health, Disability and Aged Care. Chief Medical Officer’s statement declaring syphilis a Communicable Disease Incident of National Significance. Canberra: Commonwealth of Australia; 7 August 2025. Available from: https://www.health.gov.au/news/cmo-statement-syphilis-cdins
2 Australian Centre for Disease Control. National response to syphilis. Canberra: Australian Government Department of Health and Aged Care; 10 December 2025. Available from: https://www.cdc.gov.au/topics/communicable-diseases-prevention-and-control/national-response-syphilis
3 Communicable Diseases Network Australia. Syphilis: CDNA National Guidelines for Public Health Units. Version 2.0. Canberra: Australian Government Department of Health and Aged Care; 2024.
