Remarks

• Integration: Syphilis self-testing, as with all testing approaches, should beoffered within a broader programme and package of services, which includesensuring access and linkage to confirmatory testing (where available) andimmediate treatment initiation. Opportunities to integrate syphilis self-testinginto and/or to expand existing services should be a priority.
• Quality-assured products: Syphilis self-testing may include products such asdual HIV/syphilis self-tests, treponemal self-tests and dual treponemal and non-treponemal self-tests. As with all testing approaches, syphilis self-testing shouldbe conducted using quality-assured products.
• Epidemiology and context: Policy-makers and implementers need to have aclear understanding that syphilis self-testing can be reactive with any current orprior infection by any treponematosis (e.g. syphilis, yaws, bejel or pinta) whendetermining how and where to deliver self-testing to specific populations and incertain geographies.
• Clear messages: Self-testers need to be provided with clear guidance aboutwhen they should test themselves, how to interpret their self-test results and,if needed, where to go for confirmatory testing and treatment. These furtherservices are particularly critical when single treponemal self-tests are usedthat cannot differentiate previously treated infections from current infections.In endemic areas, it is critical to clarify that reactive serologic tests cannotdifferentiate between syphilis and other treponematosis (e.g. yaws). Self-testersmay also need support tools to ensure they know how to self-test, and this caninclude instructions for use, videos, in-person demonstrations and support frompeers or community health workers. Information about testing with a partnershould also be provided, when appropriate, to encourage use of partner services.