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This report describes the incidence of syphilis in the remote area of north Queensland. The notification rate for infectious syphilis i. Between andthe non-Indigenous rate climbed from 1. A significant majority of Indigenous infectious syphilis notifications in Queensland arise in remote parts of the Northern Area Health Service NAHS in populations that historically have sustained a disproportionate burden of disease and where cases of congenital syphilis are notified almost every "Sexual health posters qld map." Notification rate of syphilis in Aboriginal and Torres Strait Islander populations, selected regions, to Remote districts where syphilis notifications are declining in Aboriginal and Torres Strait Islander populations.

As the diagnosis of syphilis in this setting usually relies on testing asymptomatic but 'at risk' individuals, a central plank of this strategy is to increase STI testing among the young 'at risk' population.

Remote area primary health care providers are requested to offer all men and women aged 15—39 at least one test for syphilis, chlamydia and gonorrhoea each year.

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Queensland Health Pathology and Scientific Services QHPSS has been the sole pathology provider to all the remote largely Indigenous communities in the three districts during the period to with a small amount of private pathology service activity occurring in the more urban non-Indigenous areas of one district.

The strategy may also have helped focus STI testing more in the 'at risk' age groups. An assessment of testing activity over time in NAHS populations outside these three districts has not been undertaken and would be complicated by multiple providers and uncertain denominators. However, the finding of decreasing notifications over a period of increased testing in remote districts strengthens the argument for a Sexual health posters qld map population level of disease in these areas.

This is good news for individuals with syphilis, and at the population level it decreases the duration of infectiousness and potentially reduces the number of new infections arising from a single source.

Sexual health services in Queensland....

Electronic data interchange improving the timeliness of notificationsthe enhanced surveillance and support provided by the Syphilis Register public health nurse in Cairns, and the increased focus on STI as a health issue in remote areas, may all be contributing to this sustained improvement in 'time to treatment'.

A final point to note is that azithromycin is now widely used in north Queensland usually a single oral dose of 1 gm for the treatment of symptomatic and screen detected cases and for contacts of the other common bacterial STI.

Time to treatment for infectious syphilis in the Northern Area Health Service, by year of notification. Only time will tell if syphilis in remote Indigenous populations in Sexual health posters qld map Queensland is declining.

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The factors outlined above suggest an improved health system response to syphilis but the downward trend in notifications needs to be interpreted with caution. The level of periodic testing coverage of an 'at risk' population that would be required assuming comprehensive investigation and timely treatment of all identified cases to achieve a specified reduction in community prevalence of syphilis, is uncertain.

Furthermore, the decrease in infectious syphilis has not yet translated into a noticeable change in congenital syphilis. Sincethere have been 12 cases of congenital syphilis notified in Queensland spread Sexual health posters qld map across the yearsand two-thirds came from these three remote districts.

Syphilis in pregnancy, long recognised as a significant cause of pregnancy loss and perinatal death in north Queensland, 5 is associated with a high population prevalence of infection. Finally, the time period for which we have reliable data is relatively brief. The natural history of syphilis may be such that there are peaks and troughs in notifications over an 8 to 11 year cycle corresponding with new infections arising as herd immunity from earlier epidemics wanes.

Despite the recent fall in notifications, syphilis persists in Aboriginal and Torres Strait Islander populations at unacceptably high levels — 52 cases per Syphilis and genital ulcer disease in Australasian Sexual Health Conference, Melbourne ; poster presentation.

Diverging trends in infectious syphilis, Queensland Australia — Australasian Epidemiological Association ConferenceMelbourne ; presentation.

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