Guidance

Appendix 3. Support for healthcare staff: FAQs and script

Published 26 August 2026

Applies to England

A discussion should be held with the patient by the setting healthcare team prior to testing. A suggested script is provided below which can be used by healthcare teams if needed: 

What is syphilis?

Syphilis is an infection caused by bacteria.

It can cause sores, ulcers, warts or a rash on your skin (sometimes called skin lesions). If it is not treated, it can sometimes cause problems with your heart, brain, nervous system or other organs in your body. These problems can be serious and life-threatening.

These symptoms happen soon after catching syphilis. If you aren’t treated for syphilis, the bacteria stay in your body, and you can be infectious to other people for about 2 years.

How is syphilis passed on?

Syphilis is passed between people by touching the skin lesions of someone who has syphilis (for example during sex). It can also be passed on from a mother to her child during pregnancy and by sharing equipment such as sex toys and needles.

How is the test carried out (dependent on testing available in the setting)?

Testing for syphilis is done in 2 stages. The first test is (depending on what test is offered):

• dried blood spot (DBS) testing, done via a finger prick - the blood spot is dried on a piece of paper and then sent to a laboratory for testing, so the results will take a little while to come back
• capillary testing is done via a finger prick, however more blood does need to be taken and collected in a Mini Tube - it is then sent to a laboratory for testing, so the results will take a little while to come back
• point-of-care testing (POCT) is done via finger prick, and the results will be available within around 15 minutes

If the first test is positive, we would want to then take a larger blood sample which will be sent to the laboratory for further testing. This will help us plan your treatment and follow up.

Treatment for a positive test: patients who are at high risk of loss to follow-up

If you have tested positive on the first test, you will be referred for treatment for syphilis, if your doctor or nurse thinks this is the best thing for you.

This first test shows us whether you have ever had syphilis. It may be that you had syphilis in the past, and you don’t need to be treated.

If you are treated after the first test, there is a risk that you might be getting treated for a syphilis infection that didn’t need any further treatment.  However, accepting the treatment may not cause you any harm.

If you would prefer to have a second test done to confirm whether or not you have syphilis before having for treatment, we will do our best to ensure you get the results and get appropriate treatment. This may take a little while (adapt according to local pathway).

The reason we may offer you treatment after one test is because:

• we are happy this treatment is safe and appropriate for you
• we understand that you might find it challenging to access healthcare which may be why you are using this outreach service
• we don’t want you miss the opportunity for treatment before we get any further results back
• we are concerned that it may not be easy for you to get your test results that will come back in a couple of weeks -we think it might be difficult for you to come back for your results
• if you think it will be difficult for you to come back and you would like to receive treatment now, we can offer you that. It may mean that we are treating an old infection that doesn’t need to be treated and the only way to know that is to wait for the full results to come back
• if your first test is positive for syphilis, we will ask you to have a second blood test to confirm whether you are currently infectious. However, we won’t delay offering you treatment based on this second test result

Treatment for a positive test: patients who are not at high risk of loss to follow-up

If your first test is positive, you will be asked to have a second blood test to try and determine how long ago you caught syphilis and whether you need further treatment. This test will be sent off to a laboratory, and the results will take a few days or weeks to come back.

If this second test is positive, you may be offered treatment for syphilis.

Potential need for re-test

If your first test is negative, but you have symptoms, you might need to have another test to check the results.