Earlier this year the Royal College of Pathologists of Australia (RCPA) put out a statement noting a 20 per cent increase in confirmed gonorrhoea cases from 2022 to 2023. The college also noted that in the same period syphilis cases were “surging”.
How should these findings be interpreted? According to Dr Melanie Bissessor, sexual health physician at the Melbourne Sexual Health Centre and clinical advisor to the Victorian HIV and Hepatitis Integrated Training And Learning (VHHITAL) program, the stark figures contain both good and bad news.
“The rise in gonorrhoea rates can often be attributed to several factors,” she said.
“It is likely that the increase reflects a combination of both improved testing and a real rise in infections. While increased testing can account for part of the rise in diagnosed cases, changes in sexual behaviour and the spread of resistant strains also play a significant role.”
A similar picture emerges for syphilis, although there are also some significant differences.
Indigenous people, noted Dr Bissessor, and especially Indigenous women, are disproportionately impacted by syphilis. This is especially so in communities in rural areas, and those with limited access to sexual health services.
“Within the broader population,” she said, “syphilis has a notably high prevalence among men who sleep with men, driven by network dynamics and specific sexual practices.
“Syphilis infection can increase the risk of acquiring and transmitting HIV, creating a synergy that exacerbates the spread within high-risk groups.”
Among this already concerning picture, there are two elements that are particularly worrying.
The first is a rise in cases of congenital syphilis – when infection passes from a mother to their baby during pregnancy or at birth, resulting in severe health impacts, including sometimes infant death.
Once again, the impact is being disproportionately felt in our First Nations communities.
“Between 2011 and 2020, there were 58 congenital syphilis notifications in Australia, with more than half among the Aboriginal and Torres Strait Islander population,” Dr Bissessor explained.
“Before 2017, there had only been two cases in Victoria.”
The other matter causing extra concern is the steady increase in sexually transmitted infections that are resistant to antibiotics.
“There is a continual emergence of resistant strains, particularly in gonorrhoea, which poses significant challenges to treatment and control efforts,” she said.
“While some strains are resistant to first-line treatments, infections are still treatable with some second and most third-tier antibiotics. However, the options are becoming limited, and the development of new antibiotics is slow.”
Dr Bissessor said that an important route towards tacking the increase in STIs was to boost testing numbers by ensuring services are easy to find and fully accessible.
Upcoming training – Sexual Health Month
Syphilis: Advanced webinar for primary care
- Date: Thursday, 5 September 2024
- Time: 6:30pm – 8:30pm
- Register here
Congenital syphilis for primary care webinar
- Date: Monday, 9 September 2024
- Time: 6:30pm – 8:30pm
- Register here
Treatment of antimicrobial resistant STIs: Mycoplasma genitalium, gonorrhoea and others
- Date: Tuesday, 10 September 2024
- Time: 6:30pm – 8:30pm
- Register here
In Victoria, Sexual Health month runs from 4-27 September 2024.
For more information about VHHITAL, including RACGP accredited CPD education and training activities, please go to this page.
For detailed treatment options for general practice, please visit HealthPathways Melbourne.
