Indications for Testing
Why testing for syphilis is important
Around 50% of people with syphilis will have no symptoms and will only be detected through routine screening.
Normalising routine syphilis testing is an important step in reducing stigma. For any sexually active patient, testing can be offered opportunistically, or as part of an annual MBS item 715 Health Check for Aboriginal and/or Torres Strait Islander people. This is particularly relevant for asymptomatic young people aged 15–35 years old.
It is important to note that identifying as Aboriginal and/or Torres Strait Islander is not in itself a risk factor. Rather, certain communities experience disproportionate impact due to systemic barriers to healthcare and longstanding historical inequities.
Prompt and appropriate testing and management of syphilis is essential to:
- Prevent the ongoing transmission to sexual partners
- Prevent the transmission from pregnant person to baby and subsequent outcomes such as miscarriage, stillbirth, and congenital syphilis
- Prevent illness caused by syphilis, including secondary and tertiary syphilis
- Reduce transmission of other STIs and blood-borne viruses (BBVs) including HIV.
Clinical Indicators
- Patients with symptoms and/or signs of syphilis (see below)
- Patients with a diagnosis or symptoms of any STI
- Pregnancy: at first antenatal visit, 26-28 weeks, and at 36 weeks/birth. *Some pregnant people may be at greater risk of syphilis and require additional tests. Additionally, some regions recommend additional universal and risk-based testing for syphilis in pregnancy. Refer to your local guidelines.
- When testing for any other STI or BBV
- Sexual contacts of people with syphilis (test and presumptively treat)
- People being assessed for HIV post-exposure prophylaxis (PEP)
Priority populations for asymptomatic testing
- Anyone who requests an STI test
- People with new sexual partner/s
- Men who have sex with men (MSM)
- People engaged in substance use
- People engaged in sex work
- people aged 15-35 years old
- Aboriginal and /or Torres Strait Islander people
- People who have been previously treated for syphilis
- People living with HIV
- People who have spent time in rural and remote communities
- Persons with unstable housing
- Persons experiencing domestic or family violence
- People who experience major mental health issues
- Persons with a history of incarceration
- People who are pregnant: at first antenatal visit, 26-28 weeks, and at 36 weeks/birth. *Some pregnant people may be at greater risk of syphilis and require additional tests. Additionally, some regions recommend additional universal and risk-based testing for syphilis in pregnancy. Refer to local guidelines.
- People who are planning a pregnancy
Symptoms and/or signs of Syphilis
