Background Globally, over two million pregnancies are affected by syphilis annually, resulting in adverse pregnancy outcomes and severe sequelae in the newborn. Cost-effective strategies exist, which prevent vertical transmission. Ghana‘s Policy recommends antenatal (ANC) syphilis screening and treatment of positive clients, but pregnant women were often not tested especially in areas where laboratory services are unavailable. The study examined the performance of point-of-care (POC) tests for screening ANC attendants for syphilis conducted by midwives at the primary level health facilities in Ghana.

Methods The study was conducted from March to September 2010. In all, 1249 pregnant women attending ANC in 8 sites were recruited and tested using Determine^® Syphilis TP (POC) and results compared with Treponema Pallidum Haem-Agglutination Test (TPHA) and Rapid Plasma Reaginin test (RPR).

Results The sensitivity of tests conducted by midwives was 25%, 60% and 75% when compared with TPHA, active syphilis (reactive to TPHA and RPR) and High titre active syphilis (HTS) (greater than 1:8) respectively. A higher sensitivity was noted in detecting active syphilis and high titre infections. The prevalence of syphilis using POC test on whole blood conducted by midwives was 5.5% (70/1282), at the district laboratory on serum samples was 10.1% (126/1248) and at the reference laboratory using TPHA was 7.7%. Active syphilis was found in 1.6% of the samples.

Conclusion Midwives can conduct POC testing for syphilis for ANC clients in rural settings in Ghana even in primary level health facilities. The ability of midwives to identify, treat 75% of HTS and provide a high coverage of syphilis screening in a rural setting makes this a suitable strategy for resource-constrained settings.

The low sensitivity compared to TPHA and active syphilis, should be addressed with training, effective supervision and monitoring of health personnel and instituting quality assurance systems for testing.