Syphilis point-of-care tests: an Australian perspective

Syphilis is a sexually and vertically transmitted infection caused by Treponema pallidum. Although preventable and curable, syphilis remains a public health challenge worldwide, disproportionately affecting communities who experience marginalisation, stigma, and discrimination. Syphilis point-of-care (POC) tests may provide a tool to enhance patient access and timely treatment. In Australia, syphilis POC tests have been incorporated into various public health screening strategies and implemented across different jurisdictions as part of the nationwide response to an expanding syphilis epidemic. These programmes use a highly sensitive and specific POC lateral flow immunoassay test that detects antibodies to T. pallidum, and have largely focused on outbreaks areas, where the burden of infectious syphilis is highest and the distance to centralised laboratories remains significant. The COVID-19 pandemic has resulted in substantial advancements in diagnostic development capabilities with many companies now pivoting to development of POC tests for sexually transmitted infections (STIs). Here we summarise types of syphilis POC tests available, their role in clinical and public health strategies in Australia, and frameworks for selection of POC tests in screening programmes.