Nations should introduce self-testing for syphilis, say sexual health researchers 

Self-testing for STIs like syphilis is cheaper, more convenient and preferred overall by users and providers and should be implemented as part of national healthcare programs say sexual health experts from Alfred Health and Monash University.

The researchers investigated the feasibility of implementing syphilis self-testing through a review of Chinese, American and Zimbabwean studies.

In general, the review published in The Lancet Public Health found self-testing delivered a more cost-effective option for sexual health screening outcomes than attendance at a facility.

It was also a more appealing test option for patients, who found it to be more convenient, private, and financially beneficial. Confidence in test results was also high.

Infectious syphilis cases have increased substantially over the past decade. In 2020, the World Health Organization estimated 7.1 million people between the ages of 15 and 49 acquired the infection and the trend has continued in recent years.

The UK reported a 75-year high for notifications last year; Australia has seen a steady increase in cases over the past 10 years, with a near-sevenfold increase in female infections.

A study of global syphilis data found an overall increase in age-standardised incidence of the infection in three decades between 1990 and 2019, but this was driven in regions with high social and economic development.

“Syphilis is still a major issue around the world, and in many nations, especially high-income countries as well, syphilis continues to rise. And that’s no different for Australia,” says Associate Professor Jason Ong, a sexual health doctor and researcher based at the Melbourne Sexual Health Centre.

While both sides of the health equation – patient and authority – see benefit in self-testing, few places around the world offer such services. Australian healthcare providers do offer rapid ‘finger prick’ tests which provide results in 15 minutes, but these require clinic attendance.

If syphilis is not treated, it can cause brain and nerve problems, eye issues and even blindness. It’s been linked with an increased risk of transmission of HIV infection.

But the problem, Ong says, is that too few people are taking tests for syphilis. With many patients being asymptomatic, the risk of easy spread is high. So too are the consequences.

Yet a course of prescribed antibiotics provides an effective treatment for the infection, so getting tests and results to those who need them has the potential to arrest the rapid increase in syphilis globally.

Reducing stigma is important – sexual health testing is still seen as a taboo subject within communities – but accessible and discreet testing could help address this.

“That’s… where the self-testing can come in,” Ong says.

“Where people don’t have to see a GP, they can potentially pick this [self-test] up from vending machines and, ideally, off the shelf from a pharmacy. I think that’s where we would ideally want the self-test to be available.

“To go back to our COVID experience, I think it just emphasised that people can do these kinds of tests themselves at home.

“People want to know their health status, and can reasonably act on the results [when they do].”

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