Syphilis and TP testing in Victorian general practices

Syphilis testing by serology and TP PCR in Victorian general practice - Novel strategies for improving syphilis testing and control.

This project aims to evaluate the impact of multiplex PCR testing for T. pallidum (TP) and HSV on syphilis detection and diagnosis in Victorian general practice and to evaluate syphilis testing in general practice against known risk factors for infection.

Patron ID: PAT077

Lead Organisation:

Alfred Health

Project Lead:

Professor Marcus Chen

Overview:

Syphilis is an important global health problem that leads to serious complications including neurological problems and stillbirth. Rates of syphilis have climbed dramatically in most high-income countries including Australia, with heterosexual populations increasingly affected for the first time in decades and rises in congenital syphilis. This includes a worsening epidemic that has spread across Melbourne resulting in large numbers of pregnant women being infected with syphilis and multiple cases of congenital syphilis, some resulting in death. This indicates that a major breakdown in syphilis control has occurred in Victoria. Existing approaches to syphilis control are failing, and new, more effective measures are urgently required.

The Australian Government Department of Health has recently recommended “Greater use of nucleic acid amplification testing for syphilis from anogenital ulcers to increase diagnosis of primary syphilis including multiplex testing with herpes testing.” Multiplex testing refers to the ability to detect multiple pathogens within a single assay. The addition of T. pallidum PCR testing to existing herpes simplex virus (HSV) PCR tests, which are frequently used in general practice, presents an opportunity to improve early detection and diagnosis of syphilis by GPs. Melbourne Pathology will be introducing the TGA approved, commercially available SpeeDx multiplex assay in September 2022.

This study will be an evaluation of:

  1. The impact of routine use of multiplex testing for syphilis (when HSV is requested) on syphilis testing and detection for tests completed through Melbourne Pathology.
  2. The broader context of syphilis testing (serology and PCR) and management in general practice.

Furthermore, the changing epidemiology of syphilis has prompted a Victorian Department of Health Chief Health Officer alert (2019) to increase awareness of the risk factors for syphilis, as well as a recent change to Australian STI management guidelines for use in primary care (ASHM). This change recommends syphilis serology for all patients requesting an STI test in primary care. Regular syphilis screening is also recommended for:

  • Aboriginal and Torres Strait Islander people under the age of 30 (or 35 in remote communities) who are not known to be in a stable, long-term monogamous relationship
  • Men who have sex with men
  • Gender diverse populations
  • Sex workers; and
  • Those with a recent history of drug use.

This project will allow evaluation of whether these guidelines are being followed in general practice.

PATRON data will be used to:

  1. Compare syphilis and TP PCR requesting, testing and detection between Melbourne Pathology and non-Melbourne Pathology pathology providers.
  2. Compare testing rates by:
    • patient characteristics and risk factors. Risk factors are determined as per the Department of Health CHO Health Advisory (25th March 2019) and ASHM Australian STI management guidelines for use in primary care (December 2021)
    • location and characteristics of GP practice (eg. Bulk billing, small/large)

3. Evaluate diagnosis, treatment and risk factors for syphilis.