This document summarizes the aims, outcomes, and recommendations of the AFAO Syphilis Forum. The forum aimed to update participants on syphilis epidemiology, transmission, testing and treatment interventions. It also sought to gather input from the community sector to contribute to developing Australia's National Syphilis Action Plan. Key recommendations that emerged included increasing syphilis testing, partner notification strategies using technology, social marketing campaigns targeted at at-risk groups, and further research on interventions like rapid testing and chemoprophylaxis. A follow up forum was proposed to review the outcomes of the National Syphilis Action Plan.

1. AFAO Syphilis Forum
Overview of Aims,
Outcomes & Recommendations
Phillip Keen
pkeen@afao.org.au

2. Aims
 Link with BBVSS National Syphilis Action Plan
process:
 Brief AFAO/NAPWA membership on the National
Action Plan
 Provide an opportunity for AFAO/NAPWA
membership and other HIV/STIs Partnership
professionals to contribute to the development of
the National Syphilis Action Plan

3. Aims
 Update participants on
 Current syphilis epidemiology
 Syphilis 101 and manifestation in PLHIV
 Mathematical modelling of outcomes from interventions
 Behavioural research
 Innovative interventions
 Rapid syphilis testing (New Zealand)
 Chemoprophylaxis
 Encourage review of STI prevention program planning
among AFAO/ NAPWA membership

4. Outcomes
 Significant increase in understanding:
 Syphilis epidemiology
 Syphilis transmission (ease of transmission)
 Manifestation (incl. neurosyphilis)
 Effective, acceptable & feasible interventions
 Considered input from the community based
HIV/STIs sector to the National Action Plan

5. Outcomes/Recommendations
 New and multi-faceted approaches needed, with action in:
 Partner notification:
 Support for development of procedures in clinical settings that utilise
anonymous ICT solutions (eg. web to SMS)
 Consider network notification strategies
 Syphilis testing:
 Increase reach by offering syphilis testing in new settings, including
exploration of outreach and community settings; partnerships with health
care workers & established clinics in establishment of these
 New technologies (eg rapid testing) to increase acceptability and enable new
settings
 Increase frequency for HSA men (4/12), focus on untested (15% of HSA)
 Attention to HIV positive men’s health monitoring & routine syphilis testing
 Consider opt-out testing

6.  Sexually Adventurous Men (SAM):
 Not a deficit model. Support for community development
approaches. Don’t problematise, just proceed.
 Agreement that asking sexually adventurous men (SAM) to reduce
partner numbers is less likely to succeed than aligning testing
frequency with partner numbers, and other strategies to reduce risks
without reducing partner numbers.
 Consider recommending re-introduction of condom use for HSA &
SAM men (who don’t consistently use them) for a limited period of
time.
 Social marketing:
 Focus on highly sexually active men (HSA) & SAM;
 Differentiate syphilis from other STIs – impact
 Highlight impact of serosorting in syphilis transmission
 Highlight ease of treatment

7.  Research:
 Build evidence base for interventions
 Clarify research questions re: blood testing for syphilis
 Surveillance:
 Build enhanced and sentinel surveillance systems across all jurisdictions
(leverage Chlamydia research infrastructure)
 Ensure comparability of data & synchronised reporting cycles
 Chemoprophylaxis trial:
 Interest and likely broad support. Drug resistance unlikely. Inexpensive
 Episodic use may suffice
 Policy & Health Service Development:
 Attention to consistency in testing guidelines
 Suggestions for new models of health service delivery; separate testing
& treatment.
 Policy work in relation to testing costs, pathology payments; aim to
reduce barriers to testing for individuals and remove impediments to
different service models eg. Rapid testing

8. Next Steps
 A second forum in late 2009 to review outcomes
of the National Syphilis Action Plan:
 Review market testing
 Mathematical modelling
 Consider implications for HIV/STIs Partnership
responses