Written by Cherie Bennett (Nursing Policy and Advocacy Lead, ASHM) and Molly Stannard (Project Manager, ASHM).
This article first appeared in the April 2026 issue of InScope, the official journal of the Queensland Nurses and Midwives’ Union (QNMU). Members of QNMU can access full issues of InScope on the QNMU website.
Putting syphilis on the radar: Clinical care, early treatment and challenging stigma in nursing and midwifery practice
SYPHILIS CASES in Australia have doubled over the past decade, climbing to record highs and prompting a Declaration of Communicable Disease Incidence in 2025.
Nurses and midwives are central to turning the tide on this escalating public health concern.
As frontline clinicians, educators and advocates, we are uniquely positioned to recognise emerging risks, promote testing and initiate timely treatment to prevent serious harm.
With increasing notifications across diverse populations, including men who have sex with men, Aboriginal and Torres Strait Islander people, and women of reproductive age, maintaining a low threshold for testing is essential.
Around 50% of syphilis infections are asymptomatic, meaning many cases can remain undetected and untreated, silently spreading through communities.
This reinforces the need for routine and proactive screening rather than symptom-based testing alone. As trusted healthcare professionals, nurses and midwives play a critical role in normalising conversations about sexual health and encouraging testing as a routine component of holistic care.
However, research facilitated by ASHM in 2024, involving over 800 Australian healthcare workers including 487 nurses, revealed a significant gap between capacity and practice.
While 88% of healthcare workers felt equipped to test or refer for STIs, only 21% reported regularly discussing STIs with patients, and just 14% conducted or recommended syphilis testing weekly.
Fewer than half of nurses (42%) reported feeling comfortable discussing sexual health with their patients.
These findings reinforce the importance of building confidence, reducing stigma, and embedding sexual health into everyday clinical practice.
Recognising risk and removing stigma
Bias and stigma remain significant barriers to timely syphilis diagnosis.
Assumptions about who is “at risk” can delay testing and contribute to missed diagnoses, particularly among women, older adults, and culturally diverse populations.
As nurses and midwives, we must actively challenge assumptions and adopt a universal, non-judgemental approach to sexual health assessment.
Simple practice shifts such as including syphilis testing in routine sexual health screens, as part of antenatal care, and in opportunistic assessments, can significantly improve early detection.
Using inclusive language, ensuring privacy, and framing testing as standard preventive care helps reduce patient discomfort and supports equitable care delivery.
The re-emergence of congenital syphilis in Australia is a stark reminder of the consequences of missed screening and treatment opportunities.
Between 2015 and 2024, 34 preventable infant deaths occurred in Australia as a result of congenital syphilis.
Syphilis in pregnancy can cause miscarriage, stillbirth, and severe neonatal complications, yet it’s treatable when diagnosed early.
National guidelines now recommend syphilis screening at least three times in each pregnancy.
If syphilis is diagnosed during pregnancy, urgent specialist advice should be sought, and active followups arranged to ensure timely treatment.
Midwives and GP’s are critical in this space, as early screening and treatment can prevent vertical transmission.
Clinical treatment: Practical considerations for nurses and midwives
Syphilis is a treatable infection, and early treatment is highly effective in preventing complications and onward transmission.
The Australian STI Management Guidelines recommends benzathine benzylpenicillin as the first-line treatment for all stages of syphilis, with dosing determined by the stage of infection.
Early syphilis (primary, secondary, and early latent) is typically treated with a single intramuscular dose, while late latent syphilis or syphilis of unknown duration requires a longer course of weekly doses.
Benzathine benzylpenicillin is the only recommended treatment during pregnancy due to its proven efficacy in preventing congenital syphilis.
For patients with a reported penicillin allergy, specialist consultation is recommended, and desensitisation may be required in pregnancy.
Nurses and Midwives play a key role in:
- identifying risk factors and recommending testing
- interpreting serology in collaboration with medical teams
- administering treatment and monitoring for adverse reactions
- coordinating follow-up serology and recall systems
- supporting partner notification and public health reporting.
Syphilis registries, available in some states and territories, can provide valuable support for clinical decision-making, staging, and follow-up.
Leveraging these systems helps ensure continuity of care, particularly in complex or remote settings.
Strengthening workforce capability through education and tools
Clinical confidence is strengthened through access to practical resources and ongoing professional development.
Decision-making tools, online learning hubs and guideline-based resources support nurses and midwives to assess risk, interpret results and manage treatment pathways effectively.
Educational initiatives led by organisations such as ASHM aim to equip the workforce with practical, evidence-based strategies for early detection and management, reinforcing that frontline nurses are key identifiers and advocates in preventing serious harm.
A proactive call to action
As syphilis notifications continue to rise across Australia, the message is clear: put syphilis on your radar.
Encouraging proactive testing without waiting for symptoms can prevent severe complications and protect the most vulnerable in our communities.
Nurses and midwives are trusted points of contact within the health system and can lead the shift toward routine, stigma-free sexual health care.
By embedding syphilis screening into routine practice, using culturally safe and non-judgemental communication, and ensuring timely treatment and follow-up, nurses and midwives can directly contribute to reducing transmission and preventing congenital syphilis.
Early testing, early treatment, and compassionate care remain the cornerstones of effective clinical practice.
