Epidemiology of syphilis in Australia: Moving toward elimination of infectious syphilis from remote aboriginal and torres strait Islander communities?

Objective: Todescribe the epidemiology of infectious syphilis among Aboriginal and TorresStrait Islander (Indigenous) people in Australia.

Designand setting: We assessed trends in national infectious syphilisnotification rates from 2005 to 2009 using Poisson regression, with afocus on geographic and demographic differences by Indigenous status. Wecompared Indigenous and non-Indigenous rate ratios over the study period andsummarised the annual changes (summary rate ratio).

Mainoutcome measures: Crude notification rates and summary rate ratios byIndigenous status, jurisdiction, sex, age group and area of residence.

Results: From2005 to 2009, in the Indigenous population, there was a substantialdecline in the notification rate for infectious syphilis nationally; as well asin the following subgroups: females, 15–29 year olds, and people living inouter regional and remote areas in the Northern Territory and Queensland. Incontrast, there was a significant (P < 0.001) upward trend in thenotification rate in the non-Indigenous population nationally; as well as inmales, in people aged 20 years and over, and in residents of metropolitanand regional areas, New South Wales, Queensland, South Australia, Victoria andWestern Australia. The highest summary rate ratios were seen in remote/veryremote areas (86.33; 95% CI, 57.45–129.74), in 15–19 year olds (64.65; 95%CI, 51.12–81.78), in females (24.59; 95% CI, 19.73–30.65), and in WesternAustralia (23.89; 95% CI, 19.82–28.82).

Conclusion: These data demonstrate that Australia has twodistinct patterns of infectious syphilis: a substantially declining occurrencein Indigenous remote communities and an increasing incidence in males residingin urban and regional areas. Given the decline in notification rates inIndigenous remote communities, now might be the right time to move towardeliminating infectious syphilis from Indigenous communities.