Maternal syphilis carries huge risk for the baby - and cases are on the rise. Photo / 123RF
Maternal syphilis carries huge risk for the baby - and cases are on the rise. Photo / 123RF
A lack of resources is hampering Auckland Sexual Health Service's ability to contact trace and control the spread of syphilis, sexual health specialist Dr Sunita Azariah says.
According to Azariah, in areas like South Auckland it is growing due to poverty and poor access to healthcare. The service is funded by the Counties-Manukau, Auckland and Waitematā DHBs.
"This has been a growing issue for the last five years," Azariah said. "And the number of cases has grown rapidly."
Auckland DHB said addressing the spread of the disease is a "major focus" for Auckland Sexual Health Service, and staffing levels are regularly reviewed.
Syphilis is a sexually transmitted infection which can be treated and cured with antibiotics. But if it isn't treated, over time it can affect the brain, spinal cord and other organs.
The Ministry of Health says syphilis has been increasing in New Zealand since 2012, particularly in men who have sex with men, but also in heterosexual men and women.
Dr Sunita Azariah sees the problem as a resourcing issue. Photo / 123RF
The disease was all but wiped out after World War II through treatment using penicillin, but it has now made a comeback. Similar increases in the disease have been seen in Australia, the UK and the US in recent years, the ministry says.
The growth in syphilis cases in the heterosexual population has also led to an increase of congenital syphilis, where a woman infected with the disease passes it onto her unborn child.
Azariah wrote a paper in the New Zealand Medical Journal in 2016, titled Auckland: City of syphilis? - which looked at the growing number of cases of the disease and how its spread could be controlled.
"I said we would see cases of congenital syphilis if we didn't get the outbreak under control and unfortunately we didn't," she said.
"We haven't been given any additional resources to cope with this outbreak and I see it as partly a resourcing issue."
Azariah said Auckland Sexual Health Service had two nurses who were carrying out contact tracing, along with their other duties. In a city the size of Auckland it was not enough to stop the spread of the potentially deadly condition.
"A lot of people affected by it are in lower socio-economic areas and their access to healthcare is an issue. In South Auckland it appears to be a bigger problem in the heterosexual community."
She said if someone was showing the telltale signs of the condition they were tested and then asked about their sexual history. This is the first step in trying to contact partners and other potential carriers.
"We ask them to contact the people they have had sexual contact with. But we don't always know if that has happened. But if they come into contact with our service we can test them and ensure they are treated."
'It's gradually getting worse'
The first sign someone has syphilis is a sore or ulcer at the site of infection.
According to the ministry it usually appears about three weeks after infection and can last between three and six weeks before it heals, with or without treatment. However, someone who doesn't get treatment remains infectious.
If the disease is left untreated it will then progress to the next stage, where symptoms include rashes, often with red or brownish spots on the palms of the hands and soles of the feet.
Other symptoms include swollen lymph glands, fever, hair loss, muscle and joint aches, headaches, tiredness, and warty growths in skin folds. If it isn't treated a small number of people will get late stage tertiary syphilis years after the initial infection which can cause damage to the heart, brain, nerves, eyes, blood vessels, liver, bones and joints.
Maternal syphilis carries huge risk for the baby - and cases are on the rise. Photo / 123RF
Dr Lindsay Mildenhall is a senior medical officer at Middlemore Hospital's Kidz First Neonatal Care unit and said the disease was more prevalent.
"I've been in paediatrics for 30 years and we never used to even see syphilis. But in the last five to 10 years it has reappeared and it's gradually getting worse."
Mildenhall said with pregnant mothers it is commonly diagnosed through their antenatal blood tests.
"If a mother has symptoms the chances of the baby getting it are 100 per cent," he said.
Mildenhall said of those cases, 40 per cent of the babies would be stillborn, miscarried, or die soon after birth.
The ESR (Institute of Environmental Science and Research) said it was finalising its data on reported cases of syphilis for the year to December 2019 and no up-to-date data was available.
Historical data showed in the second quarter of 2014 it recorded just 62 cases of the disease in Auckland over the previous 12 months and 112 nationally.
More recent figures show in the 12 months to the end of June 2019 there were 248 cases recorded in the Auckland region and 624 cases nationwide.
In June last year the Ministry of Health released its new National Syphilis Action Plan in an attempt to reverse the growth of syphilis.
Auckland DHB director of community and long term conditions Sam Titchener said addressing the spread of the disease in the region is a major focus for Auckland Sexual Health Service.
He said the DHB was working with GPs and midwives to help with the diagnosis, testing and treatment of the condition.
Titchener said since 2017 it had in place a robust contact tracing programme to actively prevent the spread of the disease.
"We regularly review our Auckland Sexual Health Service staffing levels to ensure they are at the right level to manage the syphilis contact tracing programme."
