Community based syphilis screening: feasibility, acceptability, and effectiveness in case finding

Area of Science:

• Public Health
• Infectious Disease Epidemiology
• Sexual Health

Background:

• Syphilis remains a significant public health concern, particularly among men who have sex with men (MSM).
• Traditional genitourinary medicine (GUM) clinics may not reach all at-risk populations.
• Community-based screening offers an alternative approach to increase testing accessibility.

Purpose of the Study:

• To assess the feasibility and acceptability of community-based syphilis screening among MSM.
• To compare different sample collection techniques (venepuncture vs. saliva) for syphilis screening.
• To evaluate the effectiveness of this approach in identifying new syphilis cases in at-risk populations.

Main Methods:

• Two-phase community-based syphilis screening conducted in venues frequented by MSM.
• Phase 1 utilized venepuncture; Phase 2 employed a validated saliva test.
• Evaluation involved quantitative data from testers and clinics, and qualitative data from staff.

Main Results:

• 1090 MSM were screened over 7 weeks; 62% had not attended a GUM clinic in the past year.
• High-risk sexual behaviors were prevalent (64% reported ≥2 sexual contacts in 90 days).
• Syphilis diagnosis rates were similar for both phases (1.4% vs. 1.8%), but saliva testing showed greater uptake in saunas.

Conclusions:

• Community-based syphilis screening is feasible and acceptable for at-risk MSM.
• This approach successfully reaches populations not routinely accessing GUM services.
• While unlikely to contain outbreaks alone, combined screening and health promotion strategies may enhance effectiveness.