The Ministry of Health has released its new National Syphilis Action Plan in an important step in reversing a growing number of cases of the infection. Cases of syphilis in New Zealand have been on the rise, following a similar trend in other countries.

Syphilis can be treated and cured with early intervention and antibiotics. Most women who gave birth to babies with cases of congenital syphilis in 2017 and 2018 received no antenatal care and presented to health services either in labour or in the week before labour. In some cases, positive antenatal syphilis tests were incorrectly managed or followed up.

The action plan aims to guide a coordinated and systematic response to interrupt ongoing transmission of infectious syphilis and to prevent congenital syphilis

Important aspects of the plan for midwives are:

• Ministry of Health national social marketing campaigns to promote condom use and regular STI testing
• Preventing congenital syphilis by
  • Develop educational resources on syphilis for midwives – A podcast is available at   https://www.goodfellowunit.org/podcast/syphilis-pregnant-women-congenital-syphilis
  • Continued review of congenital syphilis cases to identify system issues
  • Supporting the development of maternal syphilis guidelines to ensure consistency of syphilis management pathways
  • Ensure that local management and referral pathways are shared with midwives

The action plan will be reviewed annually to ensure New Zealand’s approach to managing the rise in syphilis cases remains up to date.

View the National Syphilis Action Plan https://www.health.govt.nz/publication/national-syphilis-action-plan

Practice advise for midwives:

• Continue the offer of routine antenatal syphilis screening at pregnancy registration for all women
• Continue to follow up blood results for women who have received early routine screening elsewhere (from GPs)
• Refer any woman with positive results as per the Guidelines for Consultation with Obstetric and related Medical Services (referral guidelines) this may be to the relevant local sexual health service for treatment and contact tracing and/or the obstetric services
• Recommend testing or retesting for syphilis at any gestation if symptoms are present: Symptoms of a primary infection include maternal ulcerative skin lesions (most common sites are vulva, vagina, anus, occasionally lips/mouth). Secondary stage symptoms include skin rashes on hands, soles of feet or other parts of the body and/or flu like symptoms
• Offer re-screening between 28-32 weeks (or at any time at the woman’s request) for women with risk factors. Although there is currently a lack of certainty in relation to the risk factors, in the following situations retesting may need to be discussed with the woman: Women who have a new sexual partner since pregnancy registration Women with more than one sexual partner during pregnancy Women with an STI diagnosed during pregnancy or whose partner is diagnosed with an STI.