Call for More Innovative Approaches to Syphilis Testing
02 Dec 2025
Researchers are calling for more use of rapid syphilis testing in Australia, especially among pregnant women, amid increasing infection rates in the country and multiple deaths caused by congenital syphilis in recent years.
A new study, published in *The Lancet*, found that rapid tests were cost effective and permitted same-day diagnosis and treatment, in contrast with lab-based testing, which, while more accurate, often takes longer to deliver results.
However, one expert from the RACGP says although the rapid tests can be useful for the general practitioners, the blood-based laboratory testing is still considered the gold standard. She added that more research and funding are required to support innovative approaches to expand testing.
RACGP Specific Interests Sexual Health Medicine Chair Dr Sara Whitburn said barriers to testing have to be overcome with innovative thinking.
She said further research and investment in a range of STI testing options will help reduce the prevalence of sexually transmitted infections in Australia.
Dr Whitburn said the STI sector was focused on innovation, increasing testing through a number of different approaches, and rapid tests formed part of the overall toolkit.
The study comes at a time when syphilis is still described as 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 recorded in 2025 to date - including 11 cases of congenital syphilis which have resulted in four infant deaths.
Lead author Ying Zhang said that though the rapid tests are less accurate, the consequences of missing an infection in pregnancy are so great that overtreatment is a better risk:
She added that the first stand-alone rapid test for syphilis was approved in 2020. The study helps answer important questions, such as which approaches to testing work best for various populations, while balancing overtreatment against missed diagnoses.
Dr Whitburn also said that this might prove particularly useful in settings where access to pathology services is limited.
She said rapid testing can help guide decisions about further testing or, in some situations, treatment based on a risk–benefit assessment made with the patient.
However, she emphasised that rapid tests are primarily useful for people who cannot access consultations or pathology services and that laboratory testing remains the standard for confirmation.
For pregnant women, researchers determined that the most effective test was the simplest and the one with the lowest cost, which is referred to as T-RTD. In contrast, better economic and health outcomes among populations with high prevalence, including men who have sex with men in urban areas, were noted in the modified dual T/NT-RTD test.
Senior study author Professor Jason Ong said that in pregnancy, a simpler test which may lead to some unnecessary treatment is preferable to missing an infection that could harm a baby.
He added that, for higher-risk men, more precise tests spare them from unnecessary treatments while still catching most cancers.
Dr Whitburn said she would continue to advocate for GPs to routinely screen patients for syphilis during STI testing and in antenatal appointments.
She said the findings are interesting, but for general practice, it remains important to maintain syphilis screening as part of routine antenatal care.
Dr Whitburn also emphasized the need for multiple testing during pregnancy, which is in line with recommendations supported by RANZCOG, the RACGP and the STI guidelines.
She said testing should be performed not only at the initial antenatal visit but again at the 28-week blood test and during postnatal care or delivery.
With higher rates of syphilis in pregnancy now seen, she said GPs can adjust their practice by ensuring testing occurs more than once, particularly as blood tests are already offered in later trimesters. For GPs wanting to refresh their knowledge of STI testing, Dr Whitburn said she strongly recommends referring to the Australian STI guidelines.
News Source: RACGP
