title: Epidemiology of syphilis in Australia: moving toward elimination of infectious syphilis from remote Aboriginal and Torres Strait Islander communities?
abstract: OBJECTIVE
  To describe the epidemiology of infectious syphilis among Aboriginal and Torres Strait Islander (Indigenous) people in Australia.
  
  
  METHODS
  We assessed trends in national infectious syphilis notification rates from 2005 to 2009 using Poisson regression, with a focus on geographic and demographic differences by Indigenous status. We compared Indigenous and non-Indigenous rate ratios over the study period and summarised the annual changes (summary rate ratio).
  
  
  METHODS
  Crude notification rates and summary rate ratios by Indigenous status, jurisdiction, sex, age group and area of residence.
  
  
  RESULTS
  From 2005 to 2009, in the Indigenous population, there was a substantial decline in the notification rate for infectious syphilis nationally; as well as in the following subgroups: females, 15-29 year olds, and people living in outer regional and remote areas in the Northern Territory and Queensland. In contrast, there was a significant (P < 0.001) upward trend in the notification rate in the non-Indigenous population nationally; as well as in males, in people aged 20 years and over, and in residents of metropolitan and regional areas, New South Wales, Queensland, South Australia, Victoria and Western Australia. The highest summary rate ratios were seen in remote/very remote 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 Western Australia (23.89; 95% CI, 19.82-28.82).
  
  
  CONCLUSIONS
  These data demonstrate that Australia has two distinct patterns of infectious syphilis: a substantially declining occurrence in Indigenous remote communities and an increasing incidence in males residing in urban and regional areas. Given the decline in notification rates in Indigenous remote communities, now might be the right time to move toward eliminating infectious syphilis from Indigenous communities.
authors.affiliation: Kirby Institute, University of New South Wales, Sydney, NSW. jwardATkirby.unsw.edu.au
authors.forename: James S
authors.initials: JS
authors.lastname: Ward
authors.forename: Rebecca J
authors.initials: RJ
authors.lastname: Guy
authors.forename: Snehal P
authors.initials: SP
authors.lastname: Akre
authors.forename: Melanie G
authors.initials: MG
authors.lastname: Middleton
authors.forename: Carolien M
authors.initials: CM
authors.lastname: Giele
authors.forename: Jiunn Y
authors.initials: JY
authors.lastname: Su
authors.forename: Craig A
authors.initials: CA
authors.lastname: Davis
authors.forename: Handan
authors.initials: H
authors.lastname: Wand
authors.forename: Janet B
authors.initials: JB
authors.lastname: Knox
authors.forename: Patricia S
authors.initials: PS
authors.lastname: Fagan
authors.forename: Basil
authors.initials: B
authors.lastname: Donovan
authors.forename: John M
authors.initials: JM
authors.lastname: Kaldor
authors.forename: Darren B
authors.initials: DB
authors.lastname: Russell
mesh_terms: D000293:Adolescent; D000328:Adult; D001315:Australia / Q000453:epidemiology; D005260:Female; D006801:Humans; D008297:Male; D013587:Syphilis / Q000208:ethnology* / Q000517:prevention & control; D055815:Young Adult; D000095283:Australian Aboriginal and Torres Strait Islander Peoples