The American journal of emergency medicine · 2026
A national survey of emergency department syphilis screening and sexually transmitted infection testing and treatment practices.
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Stanford Kimberly A, White Douglas, Mason Joseph, Buresh Christopher, Shechter-Perkins Elissa M, Faryar Kiran
Аннотация
BACKGROUND: As syphilis cases increase across the U.S., the emergency department (ED) has emerged as a critical venue for screening. However, little is known about the current ED screening landscape. This study aims to evaluate the national landscape of ED syphilis screening, identify barriers to implementation, and characterize existing infrastructure that may support expansion of syphilis screening in the ED.
METHODS: Electronic surveys were distributed via email to 281 institutions with emergency medicine residency programs. Survey responses were also solicited from institutions both with and without residency programs utilizing relevant professional society listservs and in-person conference recruitment from October 2023 through May 2024. Responses were summarized using descriptive statistics and stratified by hospital type.
RESULTS: A total of 138 unique EDs responded (105 academic, 33 non-academic). Systematic syphilis screening was reported by only 12.6% of EDs and was more frequent in academic centers. Most screening protocols were risk-based; universal screening was rare. HIV screening programs were present in 60.0% of academic and 30.3% of non-academic EDs. Most EDs relied on designated staff for result review and patient notification, but more than one-quarter reported no defined treatment location for syphilis. Commonly cited facilitators to screening included standardized guidelines, electronic medical record integration, and additional staffing, while major barriers included time constraints, limited resources, and challenges with follow-up.
CONCLUSIONS: Despite rising syphilis rates, ED-based syphilis screening remains uncommon. Existing HIV and sexually transmitted infection screening and treatment infrastructure may provide a foundation for expanding syphilis screening through operationally feasible, guideline-supported approaches.
METHODS: Electronic surveys were distributed via email to 281 institutions with emergency medicine residency programs. Survey responses were also solicited from institutions both with and without residency programs utilizing relevant professional society listservs and in-person conference recruitment from October 2023 through May 2024. Responses were summarized using descriptive statistics and stratified by hospital type.
RESULTS: A total of 138 unique EDs responded (105 academic, 33 non-academic). Systematic syphilis screening was reported by only 12.6% of EDs and was more frequent in academic centers. Most screening protocols were risk-based; universal screening was rare. HIV screening programs were present in 60.0% of academic and 30.3% of non-academic EDs. Most EDs relied on designated staff for result review and patient notification, but more than one-quarter reported no defined treatment location for syphilis. Commonly cited facilitators to screening included standardized guidelines, electronic medical record integration, and additional staffing, while major barriers included time constraints, limited resources, and challenges with follow-up.
CONCLUSIONS: Despite rising syphilis rates, ED-based syphilis screening remains uncommon. Existing HIV and sexually transmitted infection screening and treatment infrastructure may provide a foundation for expanding syphilis screening through operationally feasible, guideline-supported approaches.