The utility of syphilis point of care testing in remote Queensland communities

Abstract

The rate of infection with syphilis has been steadily climbing over the past ten years Australia-wide. Remote areas of North Queensland have also experienced a dramatic increase in infection, with a concomitant increase in cases of congenital syphilis. Geographically remote locations pose difficulties with respect to specimen transport, processing, and turnaround time. Point-of-care testing (PoCT) offers a practical solution to many of these issues, though it is not a panacea. We aimed to assess the role of syphilis PoCT for remote areas in North Queensland. Throughout 2013–2014 we performed PoCT on field and stored specimens using the SD Bioline Syphilis 3.0 and the Chembio DPP Syphilis Screen and Confirm Assay. Both assays are immunochromatographic card tests, but the Chembio assay detects both non-treponemal and treponemal antibodies. Results were compared to gold standard testing. While both tests are convenient and easy to read, neither is sufficiently sensitive nor specific to replace the gold standard of formal treponemal testing. This is especially true in areas with a low prevalence of disease. Currently our recommendation is that all patients at high risk of infection should be assessed with gold standard testing, even in the presence of a negative point-of-care test.