Epidemic infectious syphilis in inner Sydney - strengthening enhanced surveillance

Objective: To report the results of a 2001-04 enhanced syphilis surveillance program in south-eastern Sydney and a subset of cases from the Sydney Sexual Health Centre (SSHC). Methods: For all laboratory syphilis notifications, a questionnaire was sent to the referring doctor requesting demographic data, clinical information about disease classification and the presence of symptoms. Sex of partner/s and HIV status were collected from a subset of cases seen at SSHC. Results: During 2001-04, 1,275 syphilis notifications were received and 1,112 (87%) were able to be classified as 361 (28%) cases of infectious syphilis, 221 (17%) non-infectious syphilis and 530 (42%) treated syphilis. From mid 2002, an increase in the number of infectious syphilis notifications was noted. Of the 361 cases of infectious syphilis, most were in men (348, 97%). From a subset of 47 cases of infectious syphilis from SSHC, 43 (91%) were in gay men and nine (21%) had concurrent HIV infection. Conclusions: Inner Sydney has recently experienced a rapid increase in infectious syphilis affecting a defined population: men, aged 30-39, English speaking and Australian born. These results support recent reports of outbreaks among men who have sex with men, but without routine collection of additional risk factors control programs may be misguided. Implications: In light of the review of the NSW Public Health Act 1991, it is recommended that reducing barriers to the collection of HIV status and sex of sexual partners in de-identified syphilis notifications be explored as a matter of urgency.