This article {extract} was published in Communicable Diseases Intelligence Vol 30 No 1 March 2006 and may be downloaded as a full version PDF from the Table of contents page.

Results, continued

Sexually transmissible infections

In 2004, sexually transmissible infections (STIs) reported to NNDSS were chlamydial infection, donovanosis, gonococcal infections and for the first time two categories of syphilis: syphilis – infectious (primary, secondary and early latent) less than 2 years duration and syphilis – of greater than 2 years or unknown duration. The NNDSS also received reports on congenital syphilis. These conditions were notifiable in all states and territories.

Other national surveillance systems that monitor STI in Australia include the Australian Gonococcal Surveillance Programme, which is a network of specialist laboratories, and the National Centre in HIV Epidemiology and Clinical Research.

The national trends in the number and rates of STI notifications reported to the NNDSS between 2000 and 2004 are shown in Table 4. In interpreting these data it is important to note that changes in notifications over time may not solely reflect changes in disease prevalence. Increases in screening rates, more targeted screening, the use of more sensitive diagnostic tests, as well as periodic public awareness campaigns may contribute to changes in the number of notifications over time.

Age adjusted notification rates were calculated for Indigenous and non-Indigenous populations for jurisdictions that had Indigenous status data completed in more than 50 per cent of notifications. These data however, have to be interpreted cautiously as STI screening occurs predominantly in specific high-risk groups including Indigenous populations. Similarly, rates between males and females need to be interpreted cautiously as rates of testing for STI differ between the sexes.

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Chlamydial infection

Case definition – Chlamydial infection Only confirmed cases are reported. Confirmed case: Isolation of Chlamydia trachomatis or detection of Chlamydia trachomatis by nucleic acid testing or detection of Chlamydia trachomatis antigen.

Chlamydial infection continues to be the most commonly notified disease in 2004. A total of 35,189 notifications of chlamydial infection were received by the NNDSS; a rate of 175 cases per 100,000 population. This was the highest rate since surveillance of the condition commenced in 1991, and represents an increase of 14 per cent on the rate reported in 2003 (153 cases per 100,000 population). Between 2000 and 2004, chlamydial infection notification rates increased from 88 to 175 cases per 100,000 population, an increase of 99 per cent (Table 4).

Chlamydial infection notification rates were higher than the national average in the Northern Territory (820 cases per 100,000 population), Western Australia (218 cases per 100,000 population), Queensland (209 cases per 100,000 population) and the Australian Capital Territory (191 cases per 100,000 population) ( Table 3). New South Wales had the largest percentage increase in 2004 compared to 2003 (27% increase). At the regional level, the Northern Territory excluding Darwin had the highest chlamydial infection notification rate at 1,691 cases per 100,000 population (Map 3).

Map 3. Notification rates of chlamydial infection, Australia, 2004, by Statistical Division

In 2004, notification rates of chlamydial infection in males and females were 142 and 206 cases per 100,000 population respectively. In 2004, notification rates increased by 14 per cent in males and by 15 per cent in females compared to 2003. The male to female ratio remained at 0.7:1 as in the previous year. Rates in females markedly exceeded those in males in the 15–19 and 20–24 age groups with ratios of 1:4 and 1:2 respectively (Figure 27).

Figure 27. Notification rates of chlamydial infections, Australia, 2004, by age group and sex

Trends in age and sex specific notification rates between 2000 and 2004 show increases in all age groups between 15 and 34 years in both males and females (Figure 28). Since 2000, the highest average annual percentage increase occurred in the 20–24 age group (23% in males and 21% in females). However, in 2004 the annual rate of increase declined relative to 2003, for all age groups. In the 20–24 age group the annual rate increase dropped from 27 per cent to 14 per cent in males and from 26 per cent to 15 per cent in females.

Figure 28. Trends in notification rates of chlamydial infection in persons aged 10–39 years, Australia, 2000 to 2004, by age group and sex

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In 2004, data on Indigenous status was complete in 59 per cent of cases of chlamydial infection, higher than the 43 per cent reported in 2003. The combined chlamydial infection notifications in four jurisdictions with greater than 50 per cent completeness of Indigenous status (the Northern Territory, South Australia, Western Australia, and Victoria) show that in 2004, the age adjusted notification rate was 1,158 cases per 100,000 Indigenous population, and 179 cases per 100,000 non-Indigenous population ( Table 12). The age adjusted rate ratio of Indigenous to non-Indigenous was 7:1.

Table 12. Trends in age adjusted notification rates of chlamydial infections, the Northern Territory, South Australia, Western Australia, and Victoria, 2000 to 2004, by Indigenous status* - (Part A)

Year	NT			SA			Vic
	Indigenous rate	Non-Indigenous rate	Ratio†	Indigenous rate	Non-Indigenous rate	Ratio†	Indigenous rate	Non-Indigenous rate	Ratio†
2000	1,177.5	271.1	4.3	556.6	60.4	9.2	–	–	–
2001	1,412.2	348.9	4.0	452.3	95.6	4.7	–	–	–
2002	1,511.4	435.4	3.5	548.3	117.1	4.7	–	–	–
2003	1,796.1	449.8	4.0	568.3	130.6	4.4	135.1	145.3	0.9
2004	1,793.0	444.8	4.0	294.7	111.9	2.6	205.2	170.6	1.2

Table 12 - Part B: WA and total for All

Year	WA			All
	Indigenous rate	Non-Indigenous rate	Ratio†	Indigenous rate	Non-Indigenous rate	Ratio†
2000	974.6	115.5	8.4	905.5	98.1	9.2
2001	1,028.8	119.1	8.6	994.9	118.3	8.4
2002	930.4	145.7	6.4	1,014.6	145.0	7.0
2003	1,211.7	171.6	7.1	1,102.1	153.4	7.2
2004	1,280.3	202.4	6.3	1,158.5	177.8	6.5

* The rates in non-Indigenous peoples include diagnoses in people whose Indigenous status was not reported.

† Ratio of Indigenous to non-Indigenous.

Although surveillance data continues to show substantial increases in chlamydial infection notifications nationally, 2004 data suggests that the rate of increase has declined. As a large proportion of cases with genital chlamydial infection are asymptomatic, notification rates for this disease are particularly susceptible to the overall rate of testing as well as the targeted testing of certain population sub-groups. Thus this apparent abatement therefore may reflect changes in surveillance practices and public health interventions such as targeted health promotion. Data from Medicare Australia (http://www.medicareaustralia.gov.au/statistics/) show that the number of diagnostic tests performed for Chlamydia trachomatis continued to increase in 2004, but relative to 2003, the rate of increase in testing declined: 24 to 17 per cent in the 15–24 age group, 24 to 15 per cent in males in the 25–34 age group, but remained unchanged in females in this age group (Figure 29). Using the number of tests as the denominator and the number of notifications as the numerator, from 2000 through 2004 the percentage notified of the number tested in the 15–24 and in the 25–34 year age groups remained stable in both males and females (Figure 29).

Figure 29. Number of diagnostic tests for Chlamydia trachomatis and the proportion notified among 15–24 and 25–34 year age groups, Australia, 2000 to 2004, by sex

Data source: National Notifiable Diseases Surveillance System and Medicare Australia data.

Subject to the limitations of this ecological analysis and the inherent limitations of Medicare Australia data sets (which do not include tests from public laboratories), this analysis suggests that an increase in the number of tests for Chlamydia may in part account for the increase in notifications. Similarly, the data also suggests that slight decline in the rate of increase in testing may in part account for the decline in the rate of increase observed in notifications.

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Donovanosis

Case definition – Donovanosis Both confirmed cases and probable cases are reported. Confirmed case: Requires demonstration of intracellular Donovan bodies on smears or biopsy specimens taken from a lesion or detection of Calymmatobacterium granulomatis by nucleic acid testing of a specimen taken from a lesion AND clinically compatible illness involving genital ulceration. Probable case: Requires compatible sexual risk history in a person from an endemic area or a compatible sexual risk history involving sexual contact with someone from an endemic area.

Donovanosis is a sexually transmissible infection characterised by a chronic ulcerative genital disease. Although relatively uncommon, it is a disease of public health importance in Australia because it predominantly occurs in Indigenous communities. It has been identified as a potential co-factor in HIV transmission, and it is preventable.^9,10 Donovanosis is targeted for elimination from Australia through the donovanosis elimination project. In 2004,¹⁰ cases of donovanosis, six male and four female, were reported to the NNDSS. Nine cases of the total were Indigenous: five in the Northern Territory, three in Queensland and one in Western Australia. One non-Indigenous case was reported in the Northern Territory. In 2003, a total of 16 cases, all Indigenous, six males and 10 females, were notified (Figure 30). Cases ranged in age from 18 years to 74 years and the majority were aged 15–39 years.

The surveillance data indicate that the donovanosis elimination project has been successful to date (Figure 30) and requires ongoing support to achieve its target of complete eradication of donovanosis in Australia.

Figure 30. Number of notifications of donovanosis, Australia, 1999 to 2004, by sex

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Gonococcal infections

Case definition – Gonococcal infection Only confirmed cases are reported. Confirmed case: Requires isolation of Neisseria gonorrhoeae, or detection of Neisseria gonorrhoeae by nucleic acid testing or detection of typical Gram-negative intracellular diplococci in a smear from a genital tract specimen.

In 2004, 7,098 notifications of gonococcal infection were received by NNDSS. This represents a rate of 35 cases per 100,000 population, an increase of 3 per cent from the rate reported in 2003 (33 cases per 100,000 population). Nationally, there were increases in the notification rates in males (by 8%) and females (by 5%). The male to female ratio in 2004 was 2:1, unchanged in the previous three years (2001 to 2003).

The highest notification rate in 2004 was in the Northern Territory at 794 cases per 100,000 population ( Table 3), while the largest increase in the notification rate in 2004 (compared to 2003) occurred in Tasmania. In Tasmania a 21 per cent overall increase in notification rates was reported: 44 per cent increase in males and 1 per cent increase in females. In 2004 nationally, gonococcal infection rates for males and females were 47 and 22 cases per 100,000 population, respectively. The exception to this pattern was the Northern Territory, where females had higher notification rates than males (621 versus 882 cases per 100,000 population). The regional distribution of gonococcal infection notifications shows that the highest notification rate occurred in the Northern Territory (excluding Darwin) at 1,821 cases per 100,000 population (Map 4).

Map 4. Notification rates of gonococcal infection, Australia, 2004, by Statistical Division of residence

Notification rates for gonococcal infection in males exceeded those in females in all age groups except in the 10–14 and 15–19 year age groups (Figure 31). Trends in sex specific notification rates show that the increase in rates in males in the 15–19 and 20–24 age groups has continued, although there was some abatement in the increase in the male 25–29 year age group. In females, there were no marked changes in rates, with only a slight increase in rates in the 35–39 year age group (Figure 32).

Figure 31. Notification rates of gonococcal infection, Australia, 2004, by age group and sex

Figure 32. Trends in notification rates of gonococcal infection in persons aged 15–39 years, Australia, 2000 to 2004, by age group and sex

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In 2004, the data completeness (66%) of Indigenous status of gonococcal infection notifications was similar to that in 2003. The combined gonococcal infection notifications of four jurisdictions with more than 50 per cent data completeness of Indigenous status (the Northern Territory, South Australia, Western Australia and Victoria) shows that in 2004, the age adjusted notification rate was 1,351 cases per 100,000 Indigenous population and 26 cases per 100,000 non-Indigenous population: a ratio of Indigenous to non-Indigenous of 52:1 (Table 13).

Table 13. Trends in age adjusted notification rates of gonococcal infection, the Northern Territory, South Australia, Western Australia, and Victoria, 2000 to 2004, by Indigenous status* (Part A)

Year	NT			SA			Vic
	Indigenous rate	Non- Indigenous rate	Ratio†	Indigenous rate	Non- Indigenous rate	Ratio†	Indigenous rate	Non- Indigenous rate	Ratio†
2000	1,777.1	147.2	12.1	616.1	6.5	94.6	8.5	19.0	0.5
2001	2,091.8	213.3	9.8	411.2	7.2	57.1	0.0	17.6	0.0
2002	2,057.2	258.5	8.0	356.1	8.1	44.0	42.3	18.1	2.3
2003	2,019.8	181.7	11.1	371.0	14.4	25.8	25.2	26.6	0.9
2004	2,339.0	170.3	13.7	291.7	8.5	34.3	33.8	25.2	1.3

Table 13 - part B: WA and total for all

Year	WA			All
	Indigenous rate	Non- Indigenous rate	Ratio†	Indigenous rate	Non - Indigenous rate	Ratio†
2000	1,249.5	30.8	40.6	1,244.3	24.9	50.0
2001	1,557.8	17.7	87.9	1,449.2	21.0	68.9
2002	1,262.5	31.8	39.7	1,313.2	30.6	42.9
2003	1,295.0	33.2	39.0	1,191.1	28.3	42.0
2004	1,320.9	29.2	45.2	1,351.1	25.9	52.1

 

* The rates in non-Indigenous peoples include diagnoses in people whose Indigenous status was not reported.

† Ratio of Indigenous to non-Indigenous.

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Other surveillance of gonococcal infections

The Australian Gonococcal Surveillance Program (AGSP) is the national surveillance system of antibiotic susceptibility of gonococcal isolates. In each state and territory, a network of reference laboratories determine susceptibility of isolates to a core group of antibiotics using a standard methodology. The following is the summary of their 2004 report.

In 2004, a total of 3,640 isolates of gonococci were tested for antibiotic susceptibility. Eighty-five per cent of isolates were from men, of which 76 per cent were obtained from the urethra, 13 per cent from the rectum and 8 per cent from the larynx. In females, 92 per cent of isolates were obtained from the cervix.

Trends in the proportion of isolates resistant to penicillin, quinolines and tetracycline are shown in Table 14. In 2004, the proportion of isolates resistant to penicillin by plasmid mediated resistance and chromosomally mediated resistance increased by 23 and 17 per cent, respectively. Quinolone resistance also increased by 61 per cent, 92 per cent of which were resistant at a higher 'minimal inhibitory concentration' (MIC) (1 mg/L or more). This is of concern as quinolones (e.g. 500 mg of ciprofloxacin), still used for treatment in Australia, will not be effective in high level quinolone resistant isolates.

In 27 per cent of infections by strains with plasmid mediated resistance to penicillin and in 64 per cent of infections by strains resistant to quinolone, information on country where resistant strains were acquired were available. This showed that 48 per cent (51/106) of plasmid mediated resistance were locally acquired with the rest acquired from South or South East Asia. Sixty per cent of quinolone resistant strains were acquired locally and the remaining from overseas.

Table 14. Proportion of gonococcal isolates showing antibiotic resistance, Australia, 1998 to 2004

Year	Penicillin resistance (% resistant)		Quinolone resistance (% resistant)	High level tetracycline (% resistant)
	Plasmid mediated	Chromosomally mediated
1998	5.3	21.8	5.2	NR
1999	7.4	14.3	17.2	7.9
2000	8.7	10.6	17.8	9.1
2001	7.5	15.3	17.5	9.4
2002	7.1	10.9	10.0	11.4
2003	9.0	9.0	14.4	11.2
2004	11.1	10.6	23.3	13.8

Source: Australian Gonococcal Surveillance Programme.

NR Not reported.

The distribution of infections with strains resistant to different antibiotic agents varies from jurisdiction to jurisdiction and urban to rural areas within each jurisdiction. The AGSP recommends that treatment regimes should be tailored to the local patterns of susceptibility. Nationally, the AGSP recommends the use of alternative treatments to quinolones for infections acquired.

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Syphilis (all categories)

In 2004, all jurisdictions began reporting to NNDSS syphilis infections categorised as: infectious syphilis of less than two years duration; and syphilis of more than two years or unknown duration. Detailed analysis will be reported for the two categories, as well as for syphilis of all categories for the purpose of showing trends in keeping with reports in previous years.

In 2004, a total of 2,296 cases of syphilis infection of all categories were reported, representing a notification rate of 11.4 cases per 100,000 population, an increase of 13 per cent on the 10.1 cases per 100,000 reported in 2003 (Table 3). The Northern Territory continues to have the highest notification rate of syphilis (142 cases per 100,000 population), although in 2004 the rate was lower by 13 per cent from the previous year. In 2004, there were increases in notification rates only in New South Wales (by 24%), in Western Australia (by 43%) and in Victoria (by 18%). At the regional level, the highest notification rate was in the Kimberley Statistical Division of Western Australia at 344 cases per 100,000 population (Map 5).

Map 5. Notification rates of syphilis infection, Australia, 2004, by Statistical Division of residence

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Syphilis – infectious (primary, secondary and early latent), less than 2 years duration

Case definition – Syphilis – infectious (primary, secondary and early latent), less than 2 years duration Only confirmed cases are reported. Confirmed case: Requires seroconversion in past two years (specific treponemal test (e.g. IgG enzyme immunoassay, Treponema pallidum haemagglutination assay, Treponema palladium particle agglutination, Treponema pallidum immobilisation assay), or fluorescent treponemal antibody absorption reactive when previous treponemal test non-reactive within past two years OR a fourfold or greater rise in non-specific treponemal antibody titre (e.g. Venereal Diseases Research Laboratory, Rapid Plasma Reagin) in the past two years, and a reactive specific treponemal test (e.g. IgG enzyme immunoassay, Treponema pallidum haemagglutination assay, Treponema pallidum particle agglutination, Treponema pallidum immobilisation assay, or fluorescent treponemal antibody absorption) OR demonstration of Treponema pallidum by darkfield microscopy (not oral lesions), direct fluorescent antibody tests, equivalent microscopic methods (e.g. silver stains), or nucleic acid testing or non-specific treponemal test (e.g. Venereal Diseases Research Laboratory, Rapid Plasma Reagin) reagin titre of greater than or equal to 1:8 AND presence of a primary chancre (or ulcer) or clinical signs of secondary syphilis.

In 2004, a total of 596 cases of syphilis of less than two years duration were reported. This represents a notification rate of 3 cases per 100,000 population. The Northern Territory had the highest notification rate at 28.5 cases per 100,000 population in 2004 ( Table 15).

Table 15. Number and rates of notifications of syphilis of less than two years duration Australia, 2004, by state or territory and sex

	Male		Female		Total
	n	Rate	n	Rate	n	Rate
ACT	3	1.9	1	0.6	4	1.2
NSW	257	7.7	37	1.1	294	4.4
NT	27	25.7	30	31.7	57	28.5
Qld	69	3.6	23	1.2	92	2.4
SA	4	0.5	4	0.5	8	0.5
Tas	2	0.8	2	0.8	4	0.8
Vic	81	3.3	8	0.3	89	1.8
WA	25	2.5	25	2.5	50	2.5
Total	468	4.7	128	1.3	596	3.0

The notification rates of syphilis of less than two years duration for males and females were 4.7 and 1.3 cases per 100,000 population respectively. Notification rates were higher in males than in females in all jurisdictions except in the Northern Territory, where females had higher rates (26 versus 32 cases per 100,000 population). Nationally, the male to female ratio was 4:1. Notification rates in males peaked in the 35–39 year age group and in females in the 20–24 year age group (Figure 33).

Figure 33. Notification rates of syphilis of less than two years duration, Australia, 2004, by age group and sex

Data on Indigenous status was complete in 92 per cent of cases of syphilis of less than two years duration. The age adjusted notification rate was 37 cases per 100,000 Indigenous population, and 3 cases per 100,000 non-Indigenous population: a ratio of Indigenous to non-Indigenous of 14:1. Age specific notification rates show that compared to the non-Indigenous population, rates of syphilis of less than two years duration in the Indigenous population are in an order of magnitude higher and peak in a younger age group (Figure 34).

Figure 34. Notification rates of syphilis of less than two years duration,Australia, 2004, by Indigenous status

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Syphilis of more than two years or unknown duration

Case definition – Syphilis of more than two years or unknown duration Only confirmed cases are reported. Confirmed case: Does not meet the criteria for a case of less than 2 years duration AND either a reactive specific treponemal test (e.g. IgG enzyme immunoassay, Treponema pallidum haemagglutination assay, Treponema pallidum particle agglutination, Treponema pallidum immobilisation assay, or fluorescent treponemal antibody absorption) which is confirmed either by a reactive non-specific treponemal test (e.g. Venereal Diseases Research Laboratory, Rapid Plasma Reagin) OR a different specific treponemal test if the non-specific treponemal test is nonreactive AND the absence of a history of documented previous adequate treatment of syphilis, or endemic treponemal disease (e.g. Yaws).

In 2004, a total of 1,561 cases of syphilis of more than two years or unknown duration were reported: a notification rate of 7.7 cases per 100,000 population. The Northern Territory had the highest notification rate at 52 cases per 100,000 population (Table 3).

In 2004, notification rates of syphilis of more than two years or unknown duration in males and females were 9.4 and 6.1 cases per 100,000 populations, respectively ( Table 16). Notification rates were higher in males in all jurisdictions except in the Northern Territory, where both sexes had equivalent notification rates (51.3 and 52.8 cases per 100,000 population for females and males, respectively. Nationally, the male to female ratio was 1.8:1. Notification rates in males and females were similar in the younger age groups up to 30–34 years (Figure 35). In females, the rate peaked in the 30–34 age group while in males it remained high from 35 years (Figure 35).

Table 16. Number and rate of notifications of syphilis of more than two years or unknown duration, Australia, 2004, by state or territory and sex

State or territory	Male		Female		Total
	n	Rate	n	Rate	n	Rate
ACT	7	4.4	0	0	7	2.2
NSW	459	13.7	283	8.4	742	11.0
NT	54	51.3	50	52.8	104	52.0
Qld	109	5.6	89	4.6	198	5.1
SA	1	0.1	0	0.0	1	0.1
Tas	6	2.5	6	2.5	12	2.5
Vic	204	8.3	128	5.1	332	6.7
WA	101	10.2	56	5.7	157	7.9
Total	941	9.4	612	6.1	1,553	7.7

Figure 35. Notification rate of syphilis of more than two years or unknown duration, Australia, 2004, by age group and sex

Data on Indigenous status was complete in 53 per cent of cases of syphilis of more than two years or unknown duration. The combined age adjusted rate for the jurisdictions with greater than 50 per cent data completeness of Indigenous status (all jurisdictions except New South Wales and the Australian Capital Territory) was 136 cases per 100,000 Indigenous population, and 5 cases per 100,000 non-Indigenous population: a ratio of Indigenous to non- Indigenous of 27:1. Age specific notification rates showed a similar pattern with age and no single distinct peak for either Indigenous or non-Indigenous groups. Overall, rates in the Indigenous population were higher than those in the non-Indigenous by an order of magnitude (Figure 36).

Figure 36. Notification rate of syphilis of more than two years or unknown duration, Australia, 2004, by Indigenous status

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Congenital syphilis

Case definition – Congenital syphilis Both confirmed cases and probable cases are reported. Confirmed case: Requires treponemal-specific antibody titres (e.g. Treponema pallidum haemagglutination assay, pallidum particle agglutination, fluorescent treponemal antibody absorption in infant serum greater than fourfold higher than in maternal serum OR treponemal specific antibody titres in infant serum comparable with those in maternal serum and specific treponemal IgM enzyme-linked immunosorbent assay or immunofluorescence assay positive OR T. pallidum DNA in normally sterile specimen from infant (CSF, tissue) by nucleic acid testing. OR Dark field microscopy of infant lesion exudate or node aspirate smears (not oral lesions) to demonstrate characteristic morphology and motility of T. pallidum OR demonstration of T. pallidum in infant tissues by special (e.g. silver) stains OR detection of T. pallidum DNA from an infant non-sterile site by nucleic acid testing OR reactive fluorescent treponemal absorbed-19S-IgM antibody test or IgM enzyme linked immunosorbent assay and treponemal-non specific antibody titre (e.g. RPR) in infant serum greater than fourfold higher than in maternal serum AND asymptomatic infection (in the infant of an infected mother) OR foetal death in utero OR stillbirth, which is a foetal death that occurs after a 20-week gestation or in which the foetus weighs greater than 500 g and the mother is untreated or inadequately treated for syphilis at delivery. Inadequate treatment is a non-penicillin regimen or penicillin treatment given less than 30 days prior to delivery OR clinical evidence of congenital syphilis on examination on: a. Age <2years: Hepatosplenomegaly, rash, condyloma lata, snuffles, jaundice (non-viral hepatitis), pseudoparalysis, anaemia, oedema b. Age >2 years: Interstitial keratitis, nerve deafness, anterior bowing of shins, frontal bossing, mulberry molar, Hutchinson teeth, saddle nose, rhagades or Clutton joints c. Evidence of congenital syphilis on long bone X-ray d. Evidence of congenital syphilis on cerebrospinal fluid (CSF) examination Probable case: An infant (regardless of clinical signs) whose mother has been inadequately treated for syphilis during pregnancy or an infant or child who has a reactive treponemal antibody test for syphilis and any one of the following: (1) any evidence of congenital syphilis on physical examination, (2) any evidence of congenital syphilis on radiographs of long bones, (3) a reactive cerebrospinal fluid Venereal Disease Research Laboratory Titre, (4) an elevated CSF cell count or protein (without other cause), (5) reactive fluorescent treponemal antibody absorbed assay –19S-IgM antibody test or IgM enzyme-linked immunosorbent assay.

There were 11 cases of congenital syphilis notified in 2004, 10 males and one female. Six of the cases were reported in the Northern Territory, four in Queensland and one in Victoria. All but two cases were Indigenous. There has been a gradual decline in the number of congenital syphilis notified since the peak in 2001 ( Figure 37). In the Northern Territory where the rates of infectious syphilis of less than 2 years duration are highest, the highest numbers of cases of congenital syphilis continue to be reported. The occurrence of congenital syphilis could be reduced by improving access to early prenatal care.

Figure 37. Trends in notifications of congenital syphilis, Australia, 1999 to 2004