The American journal of emergency medicine · 2026
Gaps in syphilis screening for patients receiving sexually transmitted infection testing in the emergency department.
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Krueger Madelyn, Gormley Mirinda Ann, Uddin Fahad, Guess Sarah, Roth Prerana, Litwin Alain H, Moschella Phillip
Аннотация
OBJECTIVES: To assess gaps in emergency department (ED) syphilis screening in patients receiving testing for other sexually transmitted infections (STI) within a large healthcare system in Upstate South Carolina (SC).
METHODS: A retrospective cohort study of patients (aged 13+) tested for STIs (gonorrhea, chlamydia, or trichomonas) across eight EDs from 1/1/2020-12/31/2024 was examined. A missed opportunity (MO) for syphilis screening was defined as absent syphilis screening during any ED encounter where STI testing obtained. Adjusted logistic regression identified characteristics associated with a MO for syphilis screening.
RESULTS: Between 2020 and 2024 syphilis screening increased by 127.1%, occurring in 9.9% of all encounters. Patients were less likely to have a MO if they were aged 13-19 years compared to 30-34 years (aOR = 0.89, 95%CI = 0.77-1.02), attended an ED with an opt-out screening program (aOR = 0.84, 95%CI = 0.78-0.91) or had a history of any STI (aOR = 0.80, 95%CI = 0.71-0.91). Individuals were more likely to have an MO if they were female (aOR = 1.82, 95%CI = 1.65-2.00) uninsured (aOR = 1.17, 95%CI = 1.07-1.28), had one STI screen (aOR = 3.47, 95%CI = 2.95-4.09) or two STI screens (aOR = 1.19, 95%CI = 1.09-1.31) compared to three STI screens, and had no previous history of HIV (aOR = 1.77, 95%CI = 1.26-2.47) or syphilis (aOR = 2.82, 95%CI = 2.13-3.74).
CONCLUSIONS: Notable gaps exist in ED syphilis screening within patients receiving testing for other STIs. Adopting ED syphilis screening initiatives is urgently necessary to expand screening in high-risk geographic areas as recommended by the CDC.
METHODS: A retrospective cohort study of patients (aged 13+) tested for STIs (gonorrhea, chlamydia, or trichomonas) across eight EDs from 1/1/2020-12/31/2024 was examined. A missed opportunity (MO) for syphilis screening was defined as absent syphilis screening during any ED encounter where STI testing obtained. Adjusted logistic regression identified characteristics associated with a MO for syphilis screening.
RESULTS: Between 2020 and 2024 syphilis screening increased by 127.1%, occurring in 9.9% of all encounters. Patients were less likely to have a MO if they were aged 13-19 years compared to 30-34 years (aOR = 0.89, 95%CI = 0.77-1.02), attended an ED with an opt-out screening program (aOR = 0.84, 95%CI = 0.78-0.91) or had a history of any STI (aOR = 0.80, 95%CI = 0.71-0.91). Individuals were more likely to have an MO if they were female (aOR = 1.82, 95%CI = 1.65-2.00) uninsured (aOR = 1.17, 95%CI = 1.07-1.28), had one STI screen (aOR = 3.47, 95%CI = 2.95-4.09) or two STI screens (aOR = 1.19, 95%CI = 1.09-1.31) compared to three STI screens, and had no previous history of HIV (aOR = 1.77, 95%CI = 1.26-2.47) or syphilis (aOR = 2.82, 95%CI = 2.13-3.74).
CONCLUSIONS: Notable gaps exist in ED syphilis screening within patients receiving testing for other STIs. Adopting ED syphilis screening initiatives is urgently necessary to expand screening in high-risk geographic areas as recommended by the CDC.