Appendix 4. Syphilis testing for secure settings
Published 26 August 2026
Applies to England
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This publication is available at https://www.gov.uk/government/publications/guidance-on-expedited-syphilis-testing-and-treatment-for-inclusion-health-groups/appendix-4-syphilis-testing-for-secure-settings
Full guidance on the management of STIs in secure settings is available.
Sexual health risk assessment
A full sexual health risk assessment should be conducted on entry to prison at secondary screening, with the assessment to include:
- symptoms of syphilis
- sexual history including any known contacts with syphilis
- any previous syphilis diagnoses
- any previous syphilis testing
- any previous syphilis treatment (if so, contact the previous treatment centre to confirm details such as compliance with treatment)
Expedited testing and treatment protocol for secure settings
As described throughout this document, those identified at high risk of loss to follow-up may complete, or be referred to services that can complete, the expedited syphilis testing and treatment protocol.
Those at high risk to follow-up in secure settings could include:
- those on remand in prison
- those due to be released quickly or transferred
Secure settings frequently asked questions
Who carries out the test?
A member of the prison or immigration removal centre (IRC) healthcare reception team who is trained in the use of point of care testing (for high churn settings) and/or dried blood spot testing.
Quality assurance and quality control procedures should be in place, for example, maintaining a log of staff who have been trained in the test and understand the procedures for dealing with abnormal test results, as well as participation in an external quality assurance scheme in line with guidance, (see Management and use of IVD point of care test devices).
What treatment should be offered?
L3 sexual health teams should manage the treatment of syphilis. L3 sexual health teams should check the patient’s clinical history is taken into consideration when deciding on the course of treatment, as well as their specific circumstances in the secure setting, such as how long they are likely to remain in the same prison setting. L3 sexual health services should accept the referral without confirmatory testing if a point-of-care test (POCT) is used.
How should I report testing results?
Once consent is given for results to be uploaded, ensure timely input to SystmOne.
What should I do if the individual is released?
If treatment has not been completed, obtain contact information for the patient before release and the patient’s consent to pass this to their local sexual health clinic. If follow up bloods are outstanding, ensure the patient understands need for follow up blood testing, and how and when to contact their local sexual health clinics. Prison healthcare staff can also consider a referral to RECONNECT who can support with signposting to local pathways.