Background:
Considering the recent surge in congenital syphilis, novel means of reaching vulnerable populations for testing and treatment are needed. The CDC recently suggested screening outside traditional prenatal care settings might be an effective strategy. As the primary source of healthcare for many communities with limited access to care, visits to the emergency department (ED) may represent a crucial opportunity for syphilis detection and congenital syphilis prevention.
Methods:
A routine, opt-out, syphilis screening program for all ED patients under age 65 was implemented in the ED of a large, urban, tertiary care hospital in Chicago. Prior to that, testing occurred at clinician discretion following the standard of care. This study retrospectively reviewed all ED encounters among pregnant people for the two-year periods before and 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 changes in screening and diagnosis rates, as well as demographic and clinical trends.
Results:
A total of 9,165 ED encounters involving pregnant patients were identified. In the two years before the intervention, 296 of 4,764 (6.2%) encounters included testing for syphilis, which increased almost eight-fold after the intervention, to 2,307 of 4,401 (52.4%) encounters. There were 3 (1.1% of screened population) syphilis cases identified before the intervention, which quintupled to 16 (0.7%) after the intervention. Screened patients were predominantly non-Hispanic Black (94.3% before, 92.1% after) and had public insurance (72.3% before, 72.5% after), reflecting local demographics. Notably, of all pregnant patients diagnosed with syphilis through the screening program, only 5 (31.2%) were tested for other sexually transmitted infections (STIs), 7 (43.8%) presented to the ED with abdominal or pelvic pain, and none presented with symptoms of an STI.
Conclusions:
This study found that a non-targeted screening program dramatically increased syphilis screening and diagnosis rates among pregnant patients, the majority of whom did not present with concern for STI. Implementing routine ED syphilis screening in high prevalence communities will be key to addressing the syphilis epidemic, eradicating congenital syphilis, and addressing major health care disparities.