Introduction In 2009, an initiative to eliminate mother-to-child transmission (MTCT) of HIV and congenital syphilis was launched in the Americas. The region sought to develop means of increasing uptake of syphilis testing for pregnant women and key populations at risk for syphilis to ensure prompt detection and treatment with minimal loss to follow-up.

Methods For a regional consultation, a PAHO/CDC team reviewed the published and grey literature on syphilis testing to identify regional standards and gaps. In April 2014, a regional meeting was held with representatives from health ministries and technical experts in maternal and child health and laboratory diagnostics. Participants reviewed and discussed the data, reported on best practices, and identified key areas to be included in a regional policy document.

Results Participants raised several concerns, such as a lack of regional or global guidance on syphilis testing strategies for specific clinical settings being a barrier impeding elimination of MTCT of HIV and syphilis. Also, limited integration of HIV and syphilis program and operations’ systems was a “missed opportunity” to leverage efficiencies, personnel and funding in many countries. Furthermore, existing “best practices” promoting syphilis testing in different clinical settings had not been widely circulated. Participants recommended the development of a regional consensus document. In March 2015, this Guidance outlining syphilis testing algorithms in different clinical settings was published emphasising 5 areas for national programs: (1) comprehensive national policies on syphilis testing and treatment; (2) syphilis testing algorithms appropriate for specific populations or clinical (or outreach) settings, depending on laboratory capacity (e.g., rapid syphilis testing strategies); (3) ongoing quality assurance of syphilis testing; (4) procurement mechanisms supporting high-quality and affordable syphilis test kits and supplies; and (5) enhanced national reporting of syphilis cases.

Conclusion This first-ever Regional Guidance on syphilis testing will set standards on which future country assessments will be evaluated.