Background
As syphilis rates rise, emergency department (ED) screening has been proposed as an important opportunity for early diagnosis and treatment of syphilis, especially for communities with limited access to care, for whom the ED visit may represent their primary contact with the healthcare system. Given potential increased costs and resources needed for universal screening, models targeted to certain high priority groups have been proposed. However, it is unknown if these targeted screening models successfully detect the majority of syphilis cases.
Methods
In May 2019, a routine, opt-out, syphilis screening program for all ED patients under age 65 was implemented at a large, urban, tertiary care hospital in Chicago. This study retrospectively reviewed all ED encounters that included syphilis screening for the two-year period after implementation of the screening program. Syphilis cases were defined by a combination of positive serology, rapid plasma regain (RPR) titers, and clinical history derived from chart review. Descriptive statistics were used to evaluate the hypothetical sensitivity of screening models targeted to 1) only persons tested for gonorrhea or chlamydia, 2) women of reproductive age, 3) anyone receiving a blood draw, or 4) anyone receiving a complete blood count (CBC), compared to the cases detected with universal screening.
Results
A total of 37,289 individuals were screened for syphilis during the two-year study period, of whom 624 (1.7%) were considered active syphilis cases. Had syphilis screening been performed only in patients receiving testing for gonorrhea or chlamydia, only 147 cases would have been identified (23.6% sensitivity). Screening only women of reproductive age would have identified 142 cases (22.8% sensitivity). Notably, screening only patients undergoing an unrelated blood draw would have identified 516 cases (82.7% sensitivity), and screening only those receiving a CBC would have identified 472 cases (75.6% sensitivity).
Conclusions
This study found that targeted models of syphilis screening would miss a large proportion of syphilis cases. While implementation of universal ED screening may require additional resources and infrastructure, it may be the most effective strategy to address the syphilis epidemic in high prevalence communities facing major health care disparities.
Table or Figure
