Background:
Gonorrhoea is a high-burden notifiable condition, with over 260 notifications per month in the South East Public Health Unit (SEPHU) catchment in 2024. Enhanced Surveillance Forms (ESFs) provide critical epidemiological and clinical data, yet 40% of cases lack a completed ESF, impacting the ability to monitor disease trends, identify at-risk cohorts, and respond to antimicrobial resistance (AMR). The increasing prevalence of AMR in Neisseria gonorrhoeae presents a significant public health challenge, requiring robust surveillance to track resistance patterns and inform treatment guidelines. Understanding gonorrhoea transmission in priority populations, including Aboriginal and Torres Strait Islander communities, is also crucial for targeted interventions.

SEPHU must manually follow up with General Practitioners (GPs) for these cases, a process that demands significant resources. Additionally, challenges include incomplete GP contact details in surveillance systems, high caseloads leading to delays, and inconsistent data collection, all limiting the utility of enhanced surveillance.

Methods:
To address inefficiencies, SEPHU developed an automated system to improve ESF collection by standardising and cleaning GP and practice details, using text-matching algorithms (Levenshtein distance) to match cases to GPs, customising email communications to consolidate multiple cases per GP, establishing a centralised GP address book for improved contact accuracy and enabling bulk status updates in the Public Health Events Surveillance System (PHESS).

Results:

In the first automation batch, 1,015 gonorrhoea notifications pending ESFs were processed including 500 distinct GPs across 274 practices.
875 (86%) were successfully matched to GP practices, and ESF request emails were sent.
Of these, 297 (34%) ESFs were received within four weeks.
The SEPHU GP database now includes updated contact information for these GPs and practices improving future surveillance and engagement processes.

Implications for Public Health:
This automation enhances surveillance identifying high-risk transmission in priority populations, supporting evidence-based interventions and clinical guidelines, reducing manual workload and improving follow-up efficiency.

Conclusion:
Automating ESF collection improves the efficiency and accuracy of gonorrhoea surveillance, strengthening public health capacity to monitor disease transmission in vulnerable populations and improve engagement with GPs. This model can be adapted to other high-burden communicable diseases to enhance surveillance, data integrity, and targeted interventions.

Background
Since 2014, Western Australia (WA) has experienced a syphilis outbreak. Infectious syphilis notifications increased from 86 in 2013 to a peak of 846 in 2021 and 18 congenital syphilis notifications occurred between 2018 and 2023. This presentation describes WASORG’s governance, implementation, achievements and challenges for syphilis control.

Methods
The WA Syphilis Outbreak Response Group (WASORG) was formed in 2018 to control the outbreak. WASORG is co-chaired by the Aboriginal Health Council of Western Australia and WA Health and includes representation from government, Aboriginal Community-Controlled Health Services, and non-government organisations. WASORG aims to reduce the incidence of syphilis among priority populations and prevent congenital syphilis.

Results
WASORG’s achievements include:
• Formal partnership between WA Health and the Aboriginal Community Controlled Health Sector reflected in WASORG governance structure.
• Partnerships between policy makers, health service providers and affected communities, and activation of localised syphilis response teams ensured user-centred health promotion, and health professional development, and health service delivery.
• Syphilis point-of-care-testing in 43 sites across WA.
• 15% increase in syphilis testing rate and 32% decrease in test positivity since 2021 indicating reduction in disease transmission.
• 17% decrease in annual infectious syphilis notifications since 2022 and no congenital syphilis notifications in 2024.
• Plateauing of syphilis notifications in women of reproductive age.
• Mandatory reporting of syphilis testing in pregnancy at first antenatal visit, 28 and 36 weeks in the Midwives Notification System
• Published procedure for congenital syphilis case reviews (https://www.health.wa.gov.au/~/media/Files/Corporate/general-documents/Sexual-Health/PDF/Guidelines-for-review-of-congenital-syphilis.pdf)
• Proportion of pregnant people who underwent all syphilis tests appropriate to their gestation at delivery increased from 48% in July 2023 to 60% in Oct 2024.

Challenges include:
• Suboptimal syphilis testing in 40% of pregnant people.
• Although there were no congenital syphilis notifications in 2024, there was one near-miss, i.e. vertical transmission did not occur despite inadequate maternal syphilis treatment.

Conclusions
A sustained, multi-disciplinary, inter-sectoral partnership approach can reduce syphilis transmission and prevent congenital syphilis.

The Aboriginal Health Council of WA contributed to this abstract and approves its presentation. Results presented were generated in the course of outbreak control; they are not research findings.

Introduction
Gonorrhoea is a sexually transmitted infection caused by Neisseria gonorrhoeae, characterised by urethritis in men and cervicitis in women. Complications can arise. This report investigates the epidemiology of gonorrhoea in the Murrumbidgee and Southern New South Wales Local Health Districts from 2011 to 2023.
Methods
Notified gonorrhoea cases diagnosed between January 2011 and December 2023 were described in Microsoft Excel and RStudio. Demographic and antibiotic resistance information is routinely, passively collected in the Notifiable Conditions Information Management System. Additional demographic, risk history, and clinical information was requested from diagnosing clinicians. Age-standardised notification rates were calculated using 2001 Australian Bureau of Statistics population estimates.
Results
Of 1,575 gonorrhoea notifications received, additional information was requested for 1,457. Of these, 1,299 (89%) forms were returned.
Between 2011 and 2023, overall annual age-standardised notification rates per 100,000 increased 5.3 times, peaking in 2023 at 56.2 (n=240). The trend among Indigenous Australians was similar with a 5.4 times increase, peaking in 2023 at 54.9 (n=25). The overall male-to-female ratio was 2.3:1 compared to 1:1 for Indigenous Australians. Highest age-specific notification rates were among 20 to 29 year-olds for both sexes. Of male cases, 48% (434) reporting having sex with men (MSM). Twenty-five notified cases reported sex-work (1.8%). Health service type was general practitioner for more females than males (72% and 47% respectively). Genitourinary-tract only involvement was reported for 88% non-MSM males, 26% MSM and 88% females. Symptoms were present for 80% non-MSM males, 40% MSM and 40% females. Culture confirmation occurred for 328 cases (20%); critical antimicrobial resistance was not detected.
Discussion
While gonorrhoea trends in MLHD & SNSWLHD mirrored national trends of increasing notifications over time, rates remain low compared to NSW and Australia. Maintaining targeted prevention strategies for MSM and Indigenous Australians underpins ensuring ongoing control of gonorrhoea transmission.

Background: Group B Streptococcus (GBS) remains a leading cause of neonatal sepsis worldwide, despite a decline in incidence due to intrapartum antibiotic prophylaxis. Maternal rectovaginal colonization with GBS is the most common pathway for invasive disease in the newborn. We aimed to determine the serotype distribution of GBS colonizing pregnant women and causing invasive disease in infants, to inform GBS vaccine development.

Methods: We conducted a systematic literature search of Embase, MEDLINE, Google Scholar, Cochrane CENTRAL and the World Health Organisation’s International Clinical Trials Registry Platform. The study protocol was registered on PROSPERO (CRD42024529717). GBS colonization was defined as isolation by culture of GBS from either the vagina, rectum, or perianal region at any time during pregnancy. Early onset disease was defined as invasive GBS disease in infants aged 0 – 6 days after birth and late onset disease in infants 7 – 89 days after birth. Study selection, data extraction and data analysis were performed in accordance with MOOSE (Meta-analyses Of Observational Studies in Epidemiology) guidelines. We conducted random effects proportional meta-analyses to estimate the prevalence of serotypes of GBS in maternal colonizing and infant disease.

Results: We identified 315 studies that provided data on serotype distribution (24,848 GBS positive samples from pregnant women; 10,473 samples from infants with early onset disease and 8,307 samples from infants with late onset disease). The three most prevalent serotypes in maternal colonization were III (25.2%), V (17.7%) and Ia (17.4%). The three most prevalent serotypes causing early onset disease in infants were, III (43.9%), Ia (20.3%) and V (11.2%); and those causing late onset disease in infants were III (73.0%), Ia (13.8%) and Ib (5.6%), respectively.

Conclusions: Serotypes III, Ia, Ib and V appear to be responsible for the majority of Group B Streptococcus in maternal colonization and infant invasive disease.

Key words: Group B streptococcus, maternal colonization, early onset, late onset, serotype

Syphilis notifications in Australia have continued to rise since an ongoing multijurisdictional outbreak (MJSO) was declared starting in Queensland 2011, the Northern Territory in 2013, Western Australia in 2014, and South Australia (SA) in 2016. In response, we trialled next generation sequencing for Treponema pallidum in SA to enhance understanding of syphilis genomic-epidemiology and to assess its utility for MJSO investigation.
Clinical swab samples (n = 137) referred to the SA Pathology Public Health Laboratory that screened positive for T. pallidum by PCR with Ct <=34 and collection dates between February 2021 to September 2024 were processed by target enrichment library preparation using Agilent baits and sequenced on an Illumina platform. Ancestral T. pallidum lineage and then finer sub-lineages were determined for 95 South Australian genomes that passed quality assessment in context with a set of publicly available national and international sequences (n = 786) using a hierarchical Bayesian analysis of population structure approach. Linked epidemiological data for SA cases were provided by the SA Communicable Diseases Control Branch.
Sequences from SA syphilis cases were divided amongst the two ancestral lineages: Nichols and SS14, then further into eight sub-lineages. Most sub-lineages clustered extensively with other international context sequences and SA cases from these globally diverse sub-lineages mostly resided in urban areas (SS14 sub-lineages 1.1.2, 1.2.10, 1.2.11, and Nichols sub-lineages 2.5.5, 2.5.6, 2.6.8). Two SS14 sub-lineages (sub-lineage 1.1.3 and 1.1.4) predominantly clustered with sequences from cases acquired in Australia and included a number of SA cases residing in regional-remote areas. Through epidemiological findings, nine sequenced cases were identified as MJSO, their sequences were associated with SS14 sub-lineages 1.1.3, and 1.1.4; and a Nichols sub-lineage 2.6.5. Despite the small sample size, genomic evidence indicates MJSO cases in SA are caused by multiple T. pallidum strains with introductions from unknown origins.

Background: Vaccines for Group B Streptococcus (GBS) intended for pregnant women are currently undergoing clinical trials. Conducting preparatory research now can help identify factors influencing GBS vaccine acceptance, including potential challenges. Gaining this insight will allow for targeted interventions to facilitate positive consumer experiences and timely vaccine adoption as well as address anticipated barriers to vaccination.

Methods: Pregnant women residing in Australia were invited to participate in online focus group discussions (FGDs). To date, four FGDs with 17 pregnant women from South Australia (n = 6), Victoria (n = 1), New South Wales (n = 4), Western Australia (n = 2), Queensland (n = 2), Tasmania (n = 1) and the Australian Capital Territory (n = 1) have been conducted.

Results: Participants were aged between 19–43 years. The majority had completed a university degree (n = 14) and eight were employed in the healthcare sector. Despite 12 women having had babies before, only four had awareness of GBS infection and eight did not recall having a vaginal swab in their last pregnancy. Four themes were developed. 1) Baby wellbeing and safety perceptions drive acceptance, 2) GBS in pregnancy is not mainstream knowledge and this and safety concerns drive hesitancy, 3) Easy and flexible access to vaccination services will improve uptake, 4) Preferred communication strategies for pregnant women about GBS and the vaccine should be multimodal and woman centred. Perceived infant benefit was the most important driver of GBS vaccine acceptance. Safety concerns about a novel vaccine was the most prominent barrier identified. Strong messaging that highlights vaccine safety and potential infant benefits together with in-depth information about GBS infection would be required to facilitate uptake of GBS vaccines among pregnant women.

Conclusions: Preparation for GBS vaccine implementation should include efforts to increase awareness among pregnant women about GBS infection.

Keywords: Group B Streptococcus, Group B Streptococcus vaccine, maternal immunisation, maternal vaccine, vaccine acceptance

Background
Gonorrhoea notifications have been increasing in all Australian jurisdictions since 2009, apart from a brief decline in 2020, with notifications in 2024 being higher than in all previous years. This presentation reviews Western Australian (WA) systems for gonorrhoea antimicrobial resistance (AMR) surveillance and identifies gaps.

Methods
We analysed gonorrhoea AMR data recorded in WA Notifiable Infectious Disease Disease database (WANIDD) and obtained information from WA’s public health laboratory (PathWest).

Results
Culture provides AMR data in relation to seven antibiotics including ceftriaxone, the recommended treatment. PathWest has tested PCR-positive gonorrhoea samples from all non-metropolitan areas and some metropolitan areas for plasmid-mediated penicillin resistance (PPNG) using an in-house molecular test since Nov 2011. From 2023, PPNG testing has been undertaken on PCR-positive gonorrhoea samples from two private laboratories providing services in three specific regions where oral penicillin-based gonorrhoea treatment is used. All clinics undertaking point of care testing send gonorrhoea positive samples to PathWest for PPNG testing.
The proportion of gonorrhoea notifications for which AMR data are available increased from 7% in 2015 to 35% in 2024. Between 2015 and 2024, AMR increased from an average of 0.7% to 6.2% in the three regions where oral penicillin-based gonorrhoea treatment is used. In 2024, 448 (9.3%) of gonorrhoea notifications were cultured and 90.4% of these were from metropolitan Perth.

Conclusions
WA’s system of PPNG surveillance has enabled sustainability of oral-based gonorrhoea treatment in remote areas.
The small proportion of gonorrhoea notifications, especially from rural/remote areas, undergoing culture AMR testing represents a surveillance gap. Increasing prevalence of AMR gonorrhoea in South-East Asia and the frequency of direct travel between these countries and Australia, especially the resources sector workforce, mean that expansion of molecular AMR surveillance is required to prevent ceftriaxone and other AMR gonorrhoea strains becoming established in Australia.