Healthcare Professionals' Perspectives on the Direct Referral Pathway for Syphilis Management in Western Sydney.

Syphilis remains a major public health concern globally, with rising incidence contributing to preventable complications, including congenital syphilis. As such, the Western Sydney Local Health District implemented a direct syphilis referral pathway between the public health unit and sexual health services. This study aimed to explore healthcare professionals' experiences of this direct referral pathway and its perceived impact on clinical outcomes and care coordination. A qualitative study was conducted as part of a quality improvement initiative. Semi-structured interviews were undertaken with clinicians from public health and sexual health services involved in the referral pathway. Interviews were audio recorded, transcribed verbatim, and analyzed using inductive and deductive thematic analysis. Fourteen clinicians participated, including medical practitioners and registered nurses. Two overarching themes were identified: (1) proactive case follow-up as a safeguard against preventable consequences of syphilis and (2) infrastructure and interprofessional relationships as enablers of sustained coordination. Participants reported that the pathway enabled proactive engagement of high-risk populations (i.e., pregnant women), resulting in faster treatment and reduced loss to follow-up. Improved interprofessional communication, clearer roles, and access to digital tools (e.g., shared referral forms and electronic medical records) enhanced coordination. Persistent challenges included stigma, unstable housing, and difficulties engaging some patients despite repeated outreach. Clinicians perceived the direct syphilis referral pathway as improving timeliness, coordination, and equity of care for high-risk patients. Strengthened collaboration between public health and sexual health services supported integrated management, although ongoing social and structural barriers highlight the need for complementary supportive interventions.