Syphilis epidemiology and public health interventions in Western Australia from 1991 to 2009.

OBJECTIVES: To describe the epidemiology of congenital and infectious syphilis during 1991-2009, examine the impact of public health interventions and discuss the feasibility of syphilis elimination among Aboriginal people in Western Australia (WA). METHODS: WA congenital and infectious syphilis notification data in 1991-2009 and national infectious syphilis notification data in 2005-2009 were analysed by Aboriginality, region of residence, and demographic and behavioural characteristics. Syphilis public health interventions in WA from 1991-2009 were also reviewed. RESULTS: During 1991-2009, there were six notifications of congenital syphilis (50% Aboriginal) and 1441 infectious syphilis notifications (61% Aboriginal). During 1991-2005, 88% of notifications were Aboriginal, with several outbreaks identified in remote WA. During 2006-2009, 62% of notifications were non-Aboriginal, with an outbreak in metropolitan men who have sex with men. The Aboriginal:non-Aboriginal rate ratio decreased from 173:1 (1991-2005) to 15:1 (2006-2009). CONCLUSIONS: These data demonstrate that although the epidemiology of syphilis in WA has changed over time, the infection has remained endemic among Aboriginal people in non-metropolitan areas. Given the continued public health interventions targeted at this population, the limited success in eliminating syphilis in the United States and the unique geographical and socioeconomic features of WA, the elimination of syphilis seems unlikely in this state.