Appendix 5. Risks and benefits of using a point-of-contact test (POCT) for syphilis
Published 26 August 2026
Applies to England
© Crown copyright 2026
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Point of contact test (POCT) and treatment have been shown to improve continuity of care in socially excluded populations, particularly when testing is conducted in outreach settings (1).
POCTs, appropriately used, can play an important role in syphilis testing and treatment programmes, especially for individuals who rarely access health care or face challenges with follow-up visits (2).
In certain settings and among specific populations, the rapid turnaround of a positive POCT result provides an opportunity to initiate treatment for syphilis during the same visit, based on a clinical risk assessment.
Generally, POCTs are appropriate in areas with high syphilis prevalence. However, individuals who have previously been treated for syphilis should undergo laboratory-based serologic testing rather than POCT, as these individuals will treponemal antibodies (antibodies against Treponema pallidum), which remain for life once someone has been infected. As a result, POCTs will always be positive and cannot differentiate between a current, active infection and a previously treated episode, creating a risk of overtreatment, particularly in individuals with a known history of syphilis.
Furthermore, treponemal POCTs may yield false positive results, due to non-specific cross reaction. Such false positives can lead to overtreatment with benzathine penicillin or alternative antibiotics, exposing individuals to avoidable discomfort, allergic reactions, and broader antimicrobial stewardship concerns. In settings with high background prevalence of past syphilis or complex health histories these issues become more pronounced.
However, there is expert consensus that for people in inclusion health groups, or for those at very high risk of being lost to follow‑up, the personal benefits of receiving treatment early may outweigh any potential negative consequences.
There is also a risk of undertreatment due to a false-negative result in very early syphilis infection. Additionally, a POCT result cannot be used to determine the duration of treatment, as clinical assessment is required to stage infection - late or complex infections require longer courses of treatment than early syphilis. As such, this guidance recommends that confirmatory laboratory RPR testing is conducted in order to identify the stage of infection and guide management.
References
1. Johnson L and others. ‘Outreach health-care services for people experiencing exclusion in high-income countries’ The Lancet Public Health 2025: volume 10, issue 9, pages e784 to e793
2. Thompson LA and others. ‘Evaluating the Impact of Implementing and Scaling-Up the Use of Syphilis Rapid/Point-of-Care Tests (RPOCTs): An Interrupted Time Series Analysis of New Syphilis Positivity Rates in Alberta, Canada’ Clinical Infectious Diseases 2025: page ciaf651