Call for ‘more innovation’ in syphilis testing

Researchers are calling for greater use of rapid tests for syphilis in Australia, particularly for pregnant women, with disease rates soaring and congenital syphilis causing multiple deaths in recent years.
 
A new study, published in The Lancet, shows rapid testing is not only cost effective, but can also mean same-day diagnosis and treatment, compared to lab-based tests which, although more accurate, can take longer to provide a result.

However, one RACGP expert says while rapid tests ‘are part of the toolkit’ for GPs, blood tests remain the gold standard, and further research and funding is still needed to create more innovation in expanding testing.
 
Chair of RACGP Specific Interests Sexual Health Medicine Dr Sara Whitburn told newsGP ‘innovative thinking’ is needed to address barriers to testing.
 
‘That’s where further research and further investment in a range of options for STI testing is going to help us to decrease the prevalence of STIs in Australia,’ she said.
 
‘In the STI world we are looking for innovation, and we are looking for multiple ways of increasing STI testing. So, I think having the rapid tests, knowing that they’re part of a toolkit, is something to consider.’
 
The study comes as syphilis remains a ‘global public health concern’.
 
In August, Australia’s Chief Medical Officer Professor Michael Kidd declared syphilis a Communicable Disease Incident of National Significance, with more than 3500 cases already recorded in 2025, including 11 cases of congenital syphilis causing the death of four babies.
 
The new study’s lead author, Ying Zhang, said although rapid tests are not as accurate, ‘the impact of missing a syphilis case in pregnancy is so extreme that overtreatment is a lesser evil’.
 
‘The first rapid test for syphilis alone was approved in 2020, so this work is filling a knowledge gap about what works best for different groups, and getting the balance right between overtreatment and missing cases, based on the epidemiology,’ she said
 
Dr Whitburn said such an approach will ‘work well’ in places that have less access to pathology services.
 
‘You can make the decision to either make sure that further testing is given, or, in some cases, you would do the risk-benefit analysis of treatment with the person there,’ she said.
 
‘But it would really be for people who cannot access consults or pathology testing to confirm the cases.
 
‘The gold standard still is a laboratory test, so [a rapid test] will give you an indication that this person needs to have further testing.’
 
Researchers found that in pregnant women, the simplest and cheapest test (T-RTD) works best, whereas a modified version of the dual T/NT-RTD test produces better cost and health outcomes when used in populations with higher prevalence, such as men who have sex with men in urban areas.

Senior study author Professor Jason Ong said that in pregnancy, a simpler test ‘that may treat a few extra people unnecessarily’ is preferable to missing an infection that could harm a baby.
 
‘But for men at higher risk, using a test that’s more precise helps avoid unnecessary treatment while still finding most cases,’ he said.
 
Dr Whitburn said she will ‘continue to encourage GPs to do syphilis testing for anyone who presents with an STI testing request, or an antenatal appointment’.
 
‘I think [the study] is really interesting, but for general practitioners, we want to continue to support screening for syphilis as part of our routine antenatal care,’ she said.
 
Dr Whitburn said it is important for GPs to ensure pregnant patients are also tested repeatedly, in line with the latest recommendations supported by RANZCOG, the RACGP and the STI guidelines.
 
‘So, to not just test when people present for antenatal care, but at the 28-week blood test, and also, if you are doing postnatal care or deliveries,’ she said.
 
‘Just having those repeat times to test for syphilis throughout a pregnancy, because there are now higher rates of syphilis in pregnancy.
 
‘Changing our practice to make sure that we do test more than once in pregnancy is something GPs certainly can do, because we are offering blood tests again in that second and later trimesters.’
 
Dr Whitburn said for any GPs wanting to refresh their knowledge of STI testing, she ‘highly recommends’ the Australian STI guidelines.
 
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