Expanding syphilis testing: a scoping review of syphilis testing interventions among key populations

ABSTRACT

Introduction: Syphilis is an important sexually transmitted infection (STI). Despite inexpensive and effective treatment, few key populations receive syphilis testing. Innovative strategies are needed to increase syphilis testing among key populations.

Areas covered: This scoping review focused on strategies to increase syphilis testing in key populations (men who have sex with men (MSM), sex workers, people who use drugs, transgender people, and incarcerated individuals).

Expert commentary: We identified many promising syphilis testing strategies, particularly among MSM. These innovations are separated into diagnostic, clinic-based, and non-clinic based strategies. In terms of diagnostics, self-testing, dried blood spots, and point-of-care testing can decentralize syphilis testing. Effective syphilis self-testing pilots suggest the need for further attention and research. In terms of clinic-based strategies, modifying default clinical procedures can nudge physicians to more frequently recommend syphilis testing. In terms of non-clinic based strategies, venue-based screening (e.g. in correctional facilities, drug rehabilitation centres) and mobile testing units have been successfully implemented in a variety of settings. Integration of syphilis with HIV testing may facilitate implementation in settings where individuals have increased sexual risk. There is a strong need for further syphilis testing research and programs.

KEYWORDS:

• Syphilis
• screening
• key populations
• men who have sex with men
• transgender
• people who use drugs
• incarcerated

Declaration of interest

J Tucker is the recipient of two NIAID R01 grants, he is also an advisor to SESH Global, an organization that uses crowdsourcing to improve health. J Ong is funded by a post-doctoral grant from the Australian National Health and Medical Research Council (APP1104781).

H Fu is funded by a NIH/NIDA grant addressing synthetic drug use and STI in young adults.

MK Smith is funded by the Explorations in Global Health Grants from the Institute on Global Health and Infectious Diseases at the University of North Carolina Chapel Hill. The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed. Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Additional information

Funding

The manuscript was funded by the Australian National Health and Medical Research Council (APP1104781), U.S. National Institutes of Health (NIAID 1R01AI114310-01), UNC-South China STD Research Training Centre (FIC 1D43TW009532-01) and UNC Center for AIDS Research (NIAID 5P30AI050410).