Implementation and Innovation in Syphilis Diagnostics: Insights from Global Health Systems, Molecular Testing, and Self-Testing Strategies

Syphilis remains a persistent global public health problem. Given that low-cost diagnostics and highly effective therapies have been available for decades, the current epidemic is driven by structural weaknesses in health systems, stigma, absence of political will and failures to integrate new technologies into routine care. At the Shanghai 2025 Syphilis Meeting, experts highlighted the evolving landscape of syphilis diagnostics. The presentations offered an overview of our changing understanding of seronegative primary disease, reinfection patterns, and asymptomatic mucosal shedding as well as the limitations of diagnostics for neurosyphilis and novel approaches that have shown promising performance. One presentation provided new insights into congenital syphilis by demonstrating significant changes seen on fetal ultrasound and compelling data suggesting a role for new point-of-care IgM tests for risk stratification of exposed newborns. Self-testing was highlighted as an emerging strategy that leverages community engagement, decentralization, and digital technologies to reach populations historically excluded from facility-based services. Finally, a global systems-level overview offered a summary of implementation barriers for diagnostic assays, the need for sustainable adoption of point-of-care tests, and the policy deficits that impede progress. The presentations collectively illustrated the complex interplay between technology, systems design, behavioral dynamics, and policy in shaping the global response to syphilis. The path forward requires an approach that integrates novel diagnostic and digital technologies with programs designed to strengthen health systems as well as community partnerships. Such cross-disciplinary frameworks have the potential to reduce diagnostic inequities and accelerate progress toward the elimination of syphilis worldwide.