Syphilis infections have doubled in NSW over the past five years and health authorities hope a new strategy will slow their spread.
NSW Health aims to clamp down on sexually transmitted infections (STI) with boosted prevention, testing and treatment while lifting equitable access to health services.
The report, released on Friday, warns the prevalence of STIs has been increasing for more than a decade.
Syphilis infections have doubled since 2016, from 11.2 notifications per 100,000 people, to 21.2 per 100,000 people in 2021.
NSW Chief Health Officer Dr Kerry Chant said people who were sexually active should use condoms, get tested regularly and seek treatment early.
"Sexual health is an important part of health and wellbeing," Dr Chant said.
"If left untreated, STIs pose a significant risk to reproductive health and could lead to harmful outcomes for mother and baby, neonatal infections, cancer, and increased risk of other infections."
Syphilis poses the highest risk to NSW's general population because of the harm STI can cause to developing foetus during pregnancy
Syphilis and gonorrhoea infections have risen dramatically, NSW Health says.
Gonorrhoea cases are highest in people aged 25 to 29.
HIV notifications have dropped to their lowest on record, but at the same time, health authorities have seen a reduction in condom use and STI testing.
Chlamydia infections were highest in women aged 20 to 24 and men aged 30 to 39.
The strategy's focus on equity comes amid concerns over the growing disparity in STI notifications between Aboriginal and non-Aboriginal people, especially for syphilis.
Prevention models include boosting condom use and better sex education for young people.
Testing capacities will be expanded along with more training for GPs and nurses on STIs and better record keeping systems.
Treatment services will also be boosted while NSW Health looks at how it can improve access to care.
Part of the strategy includes eliminating congenital syphilis - when a baby is born with syphilis from an infected mother.
Last year, Victorian health authorities sounded the alarm over STIs as the state emerged from nearly two years of punishing lockdowns.
Testing rates dropped during the pandemic and the end of lockdowns caused concern over a rise in transmissions.