The role of syphilis self-testing as an additional syphilis testing approach in key populations: a systematic review and meta-analysis
Open accessAbstract
BACKGROUND: Syphilis is causing epidemics in many countries. Syphilis self-testing (SST) has potential to increase testing and treatment coverage in the same manner as documented for self-testing of, for example, HIV, hepatitis C virus, and COVID-19. We aimed to synthesise current evidence on the utility of SST. METHODS: We conducted a systematic review and, where possible, meta-analysis. We searched MEDLINE, Embase, CINAHL, Scopus, and Web of Science for publications published from Jan 1, 2000, to Oct 13, 2022. We included publications with original data on any syphilis rapid tests, including dual HIV-syphilis tests. Study populations were not restricted. We used random-effects meta-analysis to calculate the pooled proportion of people offered SST who undertook the test. The systematic review was registered in PROSPERO (CRD42022302129). FINDINGS: In total, 40 499 citations were identified. 11 publications from seven studies from the USA, Zimbabwe, and China met eligibility criteria. Of those, four studies reported data from men who have sex with men and five studies used dual HIV-SST. Using data from one randomised controlled trial and three observational studies, the pooled proportion of people who received SST kits who undertook the test was 88% (95% CI 85-91). No studies provided data on the sensitivity or specificity of SST. Overall, user and provider preference for SST was high, with participants reporting convenience, privacy, rapid results, autonomy, trust in blood-based tests, decreased facility contact, and time savings, with individuals being able to correctly self-test. Publications from China reported that SST had lower costs per person tested than existing facility-based testing options. INTERPRETATION: Our review builds on the literature for self-testing across different disease areas and demonstrates that SST has the potential to reach underserved populations. As this review found that SST use was acceptable and feasible to implement, SST can be used as an additional syphilis testing approach. Since no data on the sensitivity and specificity of SST were found, further implementation research will be required to guide the best strategies for SST service delivery and future scale-up. FUNDING: WHO, Australian National Health and Medical Research Council, and Unitaid.
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Syphilis self-tests and dual HIV/syphilis self-tests improve uptake of syphilis testing.
“Syphilis self-tests and dual HIV/syphilis self-tests were found to improve uptake of syphilis testing.”
From Updated recommendations for the treatment of Neisseria gonorrhoeae, Chlamydia trachomatis, and Treponema pallidum (syphilis) and new recommendations on syphilis testing and partner services (2024) · cites this paper as Towns et al., 2023 (60)
The Results report high use of syphilis self-tests, including dual HIV/syphilis tests: 88% of people who received kits undertook testing. But the Discussion calls increased testing coverage a promising possibility, rather than establishing that either type of self-test improved uptake compared with existing testing; the evidence was largely from key populations in three countries. The claim states that improvement more definitively than the review does. (LLM, conf=0.86)
Experimental — accuracy not yet measuredSyphilis self-tests and dual HIV/syphilis self-tests can be correctly used by individuals and provide accurate results.
“Syphilis self-tests and dual HIV/syphilis self-tests can be correctly used by individuals and provide accurate results.”
From Updated recommendations for the treatment of Neisseria gonorrhoeae, Chlamydia trachomatis, and Treponema pallidum (syphilis) and new recommendations on syphilis testing and partner services (2024) · cites this paper as Towns et al., 2023 (60)
The review reports that individuals were able to correctly self-test (Abstract), supporting the claim about use. But the Results and Discussion state that no studies provided sensitivity or specificity data for syphilis self-testing, so the claim that the tests provide accurate results is not established by this source. (LLM, conf=0.90)
Experimental — accuracy not yet measuredSyphilis self-testing may not make a difference to the proportion of people with a reactive syphilis test result compared with standard testing.
“syphilis self-testing may not make a difference to the proportion of people with a reactive syphilis test result compared with the standard testing approach.”
From Updated recommendations for the treatment of Neisseria gonorrhoeae, Chlamydia trachomatis, and Treponema pallidum (syphilis) and new recommendations on syphilis testing and partner services (2024) · cites this paper as Towns et al., 2023 (60)
Syphilis self-testing, including dual HIV/syphilis self-testing, was well accepted and desirable overall.
“Syphilis self-testing, including dual HIV/syphilis self-testing, was well accepted and desirable overall (62, 63, 67-69).”
From Updated recommendations for the treatment of Neisseria gonorrhoeae, Chlamydia trachomatis, and Treponema pallidum (syphilis) and new recommendations on syphilis testing and partner services (2024) · cites this paper as Towns et al., 2023 (60)
Syphilis self-testing or dual HIV/syphilis self-testing did not appear to show different results in linkage to care compared with standard syphilis testing.
“Syphilis self-testing or dual HIV/syphilis self-testing also did not appear to show different results in terms of linkage to care when compared with standard syphilis testing.”
From Updated recommendations for the treatment of Neisseria gonorrhoeae, Chlamydia trachomatis, and Treponema pallidum (syphilis) and new recommendations on syphilis testing and partner services (2024) · cites this paper as Towns et al., 2023 (60)
Syphilis self-testing, including dual HIV/syphilis self-testing, appeared to be cost-effective and affordable compared with standard laboratory-based syphilis testing.
“Syphilis self-testing, including dual HIV/syphilis self-testing, appeared to be cost-effective and affordable compared with standard laboratory-based syphilis testing.”
From Updated recommendations for the treatment of Neisseria gonorrhoeae, Chlamydia trachomatis, and Treponema pallidum (syphilis) and new recommendations on syphilis testing and partner services (2024) · cites this paper as Towns et al., 2023 (60)
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Cites
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- Authors
- Towns, J. M., Tieosapjaroen, W., Mello, M. B., Baggaley, R. C., Johnson, C. C., Jamil, M. S., Rowley, J., Barr-DiChiara, M., Terris-Prestholt, F., Chen, M. Y., Chow, E. P. F., Fairley, C. K., Zhang, L., & Ong, J. J.
- Affiliations
- The Alfred Hospital (AU)
- World Health Organization (CH)
- The University of Melbourne (AU)
- Corresponding author
- Ong, Jason J
- ORCID
- Venue
- The Lancet Public Health
- Publisher
- Elsevier BV
- Published
- 2023-09
- Volume
- 8
- Issue
- 9
- Pages
- e726-e734
- ISSN
- 2468-2667 (ISSN-L)
- OpenAlex
- W4385077367
- Cited by
- 25
- References
- 5
- Citations by year
- 2026: 6 · 2025: 12 · 2024: 7
- FWCI
- 0.90
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Licence
- Locations
- The Lancet Public Health (publishedVersion, cc-by-nc-nd)
- PubMed (publishedVersion)
- LSHTM Research Online (London School of Hygiene and Tropical Medicine) (acceptedVersion)
- Minerva Access (University of Melbourne) (submittedVersion, cc-by-nc-nd)
- Warwick Research Archive Portal (University of Warwick) (submittedVersion)
- Funders
- United States Agency for International Development
- Bill and Melinda Gates Foundation
- World Health Organization
- Medical Research Council (GNT1172873)
- National Health and Medical Research Council (1172900, 1193955, 2003399, 1172873)
- Topics
- Health Sciences › Medicine › Physiology › Syphilis Diagnosis and Treatment
- Health Sciences › Medicine › Infectious Diseases › HIV/AIDS Research and Interventions
- Life Sciences › Immunology and Microbiology › Microbiology › Reproductive tract infections research
- Keywords
- key populations, men who have sex with men, rapid testing, feasibility and acceptability, underserved populations
- MeSH terms
- Sexual and Gender Minorities, Self-Testing, COVID-19, Australia, Humans, Male, Syphilis, HIV Infections, Homosexuality, Male
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