Barriers and facilitators associated with the intention to seek syphilis testing in a university setting: a cross-sectional study

Syphilis is surging worldwide, with low testing especially among young adults. This cross-sectional study explores barriers and facilitators of syphilis testing intentions at a Japanese university. Seven hundred twenty-six students and staff participated in a sexually transmitted disease survey (August–October 2024). Logistic regression analyses examined the associations of individual barriers and facilitators, and the cumulative number of these factors, with syphilis testing intention. Fear of being tested (adjusted odds ratio (AOR) 0.34; 95% confidence interval (CI) 0.15–0.77), low risk perception (AOR 0.31; 95% CI 0.13–0.77), a new relationship (AOR 0.33; 95% CI 0.12–0.93), regular check-ups (AOR 0.02; 95% CI 0.002–0.32), and awareness of the testing procedure (AOR 0.35; 95% CI 0.16–0.75) were associated with lower testing intention. Conversely, financial concerns (AOR 3.05; 95% CI 1.08–10.53), a partner’s positive diagnosis (AOR 3.20; 95% CI 1.42–7.88), having symptoms (AOR 2.19; 95% CI 1.06–4.56), family or friends’ recommendation for testing (AOR 35.27; 95% CI 2.11–593.54), and increased awareness about testing services (AOR 2.41; 95% CI 1.12–5.34) were associated with higher testing intention. Personal facilitators significantly trend toward higher testing intentions (p = 0.02). This study identified key psychological, personal, and structural factors associated with syphilis testing intention. Interventions that strengthen peer and partner support, improve risk perception, and reduce fear about testing may help encourage syphilis testing.