23-year-old soon-to-be doctor Shakayla Walley-Wihongi, with a team of scientific powerhouses, has blazed a trail in the treatment of syphilis.

In its most dangerous form of mother-to-child transmission (MTCT), the illness claims the lives of 40 per cent of babies born with congenital syphilis. However, perinatal death is 100 per cent preventable.

Syphilis remains at an all-time high with a 251 per cent increase in Australia in the last decade, according to the University of New South Wales' annual surveillance report released in 2023.

Ms Walley-Wihongi graduated with her Honours in Biomedical Science at the University of Notre Dame with the penicillin team at The Kids Research Institute Australia, a research facility that focuses on improving the lives of children who require medical support.

The Australian syphilis epidemic disproportionately impacts two distinct populations: heterosexual Aboriginal and Torres Strait Islander Mob whose residences are dispersed across rural and remote communities, and urban living men who have sex with men.

Ms Walley-Wihongi's primary supervisor, Associate Professor Laurens Manning of the University of Western Australia's Medical School, conceptualised the subcutaneous infusion of benzathine penicillin G (SCIP) with the wider Penicillin team, before Shakayla's academic journey.

A/Prof Manning leads the Penicillin team at The Kids and is the co-senior author of Shakayla's first scientific publication Subcutaneous Infusion of Benzathine Penicillin G Is Acceptable and Preferred Over Intramuscular Injections for Syphilis in Western Australian Sexual Health Clinic Attendees: A Mixed Methods Sub‐study.

Ms Walley-Wihongi has likened the current treatment for syphilis to "having toothpaste injected in each buttock" and said "imagine healing from that injection to receive it [BPG] again".

In accordance with Australian treatment guidelines for syphilis, an intramuscular injection of benzathine penicillin in each buttock for three consecutive weeks is recommended for late-latent syphilis using a large needle. SCIP proposes a pathway that addresses treatment barriers such as pain and impractical treatment schedules and aims to improve treatment success.

Shakayla's honours project reports on the treatment experiences and preferences of syphilis patients at a sexual health clinic in Walyalup (Fremantle), with participants reporting a preference for the subcutaneous penicillin infusion, substantiated by reports of minor pain and discomfort. The honours student's team hopes to change guidelines to reduce three clinic visits to a single treatment visit.

The Penicillin team in which Ms Walley-Wihongi works has also collaborated with researchers in Aotearoa who are implementing SCIP as treatment for acute rheumatic fever and rheumatic heart disease. Ms Walley-Wihongi told National Indigenous Times that "children often miss school" and "need to be held down crying, screaming to take the injection".

Western Australia's Country Health Services policy - Intramuscular Benzathine Benzylpenicillin G for Acute Rheumatic Fever and Rheumatic Heart Disease - states that treatment occurs every 21 to 28 days. The alternative is that Strep A scars the heart valves, in the worst-case scenario, this can cause heart failure and be fatal.

Due to the high-dose injection of penicillin, young people are provided with protection from break through Strep A infection for 10 weeks. SCIP would reduce 13 annual clinic visits to five annual clinic visits in the case of ARF/RHD. It is known that regular clinic visits for essential treatments can pose a financial burden and psychologically exhaustive weight that often pulls individuals away from community responsibilities.

The difference between intramuscular injection and subcutaneous infusion is how deep the medicine is injected. Intramuscular injection delivers the viscous substance deep into the muscle whilst the high-dose subcutaneous infusion requires a shorter, smaller needle that is inserted in the fat just beneath the skin.

The conclusion of the paper Subcutaneous Infusion of Benzathine Penicillin G Is Acceptable and Preferred Over Intramuscular Injections for Syphilis in Western Australian Sexual Health Clinic Attendees: A Mixed Methods Sub‐study handed down promising results for single-dose solutions which pose a major advantage to achieving treatment success for syphilis and ARF/RHD.