Syphilis Screening and Treatment

Although treatment for syphilis is included in the syndromic algorithms for genital ulcers, many cases of syphilis could be missed by using this criteria alone because a person could be infected with syphilis without having a genital ulcer. Fortunately, there is a simple and cost-effective laboratory test that can be used to screen patients for syphilis and that can provide results the same day as the patient visit. This test is best utilized among patient populations that have a high rate of infection, such as at STD clinics, STD patients in primary care settings, or in ante-natal clinics where untreated syphilis can have catastrophic effect on birth outcomes. As an example, Jamaica decentralized and implemented just such a screening program in an attempt to reduce their high syphilis rates. Laboratory aides and assistants with little laboratory experience learned how to perform syphilis blood tests at the clinic sites. And although some people were skeptical that this level of health worker could perform the test accurately, a quality control assessment confirmed 96 percent of the results of the syphilis tests performed by the lab aides. In Jamaica, syphilis screening is now available at 76 ante-natal clinics and 17 STD clinics. As a result, 68 percent of those who test positive for syphilis are treated the same day, and 85 percent received treatment in less than one week. This contributed to the 50 percent decline in infectious syphilis found over a 2 year period.²⁴