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NACCHO and ASHM

How to Test

Treponemal screening tests: Point-of-Care tests

Last Updated: June 2026

Syphilis Point-of-Care-Tests (PoCT) can be a useful addition to laboratory testing and can lead to a reduction in the time interval between testing and treatment. The Abbott Determine™ Syphilis TP immuno-chromatographic test strip is currently the only syphilis PoCT registered by the Therapeutic Goods Administration in Australia.

Benefits:

Limitations:

  • accessible testing for those reluctant or unable to have venepuncture performed
  • reduced impacts of infection
  • reduced time to initiating treatment (if there is no syphilis history)
  • reduced time to initiating contact tracing
  • less onward transmission to others
  • reduced follow-up burden on primary care services
  • reduced loss to follow up
  • PoCT cannot differentiate a new infection from a previously treated infection, and it will always return a reactive result (therefore do not use PoCT on people who have EVER had a reactive treponemal test)
  • in remote areas with previous endemic syphilis, a significant number of people aged over 40 years will return a reactive result
  • PoCT is unlikely to identify a syphilis infection in the early stages (i.e. the first three weeks of infection and serology testing should be conducted in parallel).
  • If reactive, venous blood is still required to be sent to the laboratory for RPR testing

In settings where PoCT is used, staff should:

  • be appropriately trained and comply with certification and manufacturer instructions; this includes training to conduct testing, interpret results, undertake quality control, record results and report test results accurately to the patient
  • be provided with appropriate PoCT Guidelines and manuals
  • ensure quality control and assurance testing are regularly conducted
  • comply with surveillance, monitoring and notification requirements

Syphilis Point-of-Care Testing (PoCT)

Test type

Sample required

Main use

Treponemal test: identify syphilis specific Treponemal antibodies

Whole-blood samples: finger-prick or venepuncture

Screening in:

  • priority populations
  • people with no known syphilis history
  • designated outbreak regions
  • people who are at risk of not returning for treatment
  • settings where community-based screening is undertaken outside of the clinic and outreach settings
  • settings where there is a long wait for pathology results
  • patients who are reluctant or unable to have venepuncture performed for syphilis serology at the time of consult

NOTE: A PoCT should only be used on people who have never had a reactive treponemal or screening test. This is because once it’s reactive it will remain reactive for life.

Point-of-care test strip showing a reactive result (control and patient lines)

Reactive result:

If a patient’s last documented syphilis PoCT was non-reactive, and the PoCT is reactive, this indicates a new infection acquired since the last test.

  • Clarify when the patient had their last negative test (i.e. less than 2 years or 2+ years by:
    • reviewing previous syphilis serology and/or
    • discussing the case with your local syphilis register or Public Health Unit to check if patient has ever had previous screening tests and treatment Note: where the last negative PoCT was NOT accompanied by serology, treatment decisions may vary between clinicians and services. A risk assessment may be used to inform the decision, while others may take a precautionary approach and treat as 2+ years.
  • Send venous blood to the laboratory for syphilis testing – laboratory testing will inform the treatment regime required.
  • Commence treatment as a new infection.

If there is no previous testing history and the PoCT is reactive, this indicates the patient has been infected with syphilis but does not tell you when.

  • Contact your local syphilis register or Public Health Unit to check if patient has ever had previous screening tests and treatment. In addition, seek support from appropriate clinician or Aboriginal Health Worker when needed.
  • Commence treatment if the patient has any symptoms, are a contact, are at high risk of syphilis, or if they are experiencing barriers to access care and cannot return for results of laboratory testing.
  • Send venous blood to the laboratory for syphilis testing – laboratory testing will inform the treatment regime required.

A decision to treat must consider whether the benefit of immediate treatment outweighs the risk of a potential misdiagnosis (i.e. not having syphilis) or loss to follow-up.

Point-of-care test strip showing a non-reactive result (control line only)

Non-Reactive result:

  • Venous blood does not need to be sent to the laboratory for syphilis screening unless there is concern about very recently acquired syphilis or symptoms suggestive of syphilis. However, best practice is for serology testing to be conducted in parallel.

Recording Results:
ALL PoCT results (both reactive and non-reactive) must be recorded in the patient’s medical record, as per local protocols.

References:

  • Miller P, Skov S, Knox J. How to interpret syphilis results: a manual for nursing and medical staff in remote communities. 2nd ed. South Australia: Nganampa Health Council Inc.; 1999. Available from: http://www.nganampahealth.com.au/
  • Government of Western Australia Department of Health, Kimberley Aboriginal Medical Services Council. Clinical audits conducted at various ACCHS by J Knox. Perth: WA Department of Health; 2009–2013. Unpublished internal report.
  • Government of Western Australia Department of Health. Chapter 7: Improving the testing and management of syphilis. In: Let’s Yarn! Talk Test Treat Trace Manual [Internet]. Perth: WA Department of Health; [cited 2026 Feb 9]. Available from: https://letsyarn.health.wa.gov.au/talk-test-treat-trace/chapter-7