The rate of syphilis detection in emergency rooms is more than twice as high

Media Advisory

Tuesday September 10, 2024

NIH-funded research shows the potential of a strategy that can reach both people with and without symptoms.

Colorized electron microscope image of the bacteria Treponema pallidum, which causes syphilis. Pink highlights several spiral-shaped bacteria.NIAID

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According to a National Institutes of Health-funded study of more than 300,000 emergency room visits in Chicago, offering optional syphilis testing to the majority of people seeking medical care led to a significant increase in syphilis diagnosis and screening. The majority of those diagnosed had no symptoms. This suggests that using symptom-based tests alone may miss the opportunity to diagnose and treat syphilis. These findings were published today in the journal Open Forum Infectious Diseases.

According to the Centers for Disease Control and Prevention, adult and congenital syphilis increased by 80 % and 183 % between 2018 and 2020. It will be important to improve syphilis diagnostic strategies to reach populations such as pregnant women or those with limited access. Identifying the optimal syphilis screening model, particularly for the prevention of congenital disease, has been challenging. Previous literature supports targeted syphilis screening in the emergency department based on factors such as active symptoms and pregnancy. The screening criteria for these models do not include most people with asymptomatic syphilis.

The current study team introduced a syphilis screening strategy that included an optional test to be offered to individuals whose electronic records indicated their age was between 18 and 64 years and who had never been tested for HIV. Clinical decision-making could also be used to order syphilis tests for individuals who did not meet the criteria. This study, conducted in a large urban academic emergency department, assessed screening and diagnostic outcomes from June 2017 to May 2021. Two years before, it assessed screening and diagnostic outcomes, while two years after, it measured screening and diagnoses.

Only 5,209 of 146,644 people, or 3.6 µg/mL, were tested for syphilis before the intervention. After the intervention, syphilis screening increased to 37,289 of 153,007 (or 24.4 µg/mL) of all emergency department visits. According to the study's testing algorithm, 624 people had presumed active syphilis infection after the intervention. A small percentage of those with syphilis were symptomatic or had been tested for a sexually transmitted infection. The proportion of pregnant women who were screened increased from 272 of 4,579 (4.9 µg/mL) before the intervention to 2,061 of 4,129 (50.9 µg/mL) after the intervention. The number of confirmed syphilis cases among pregnant women increased from 2 before the interventions to 15, while the positive rate remained constant. This suggests that many opportunities to establish a diagnosis before the intervention were missed. The concomitant diagnosis of syphilis with HIV increased from 7 to 24 cases without additional HIV testing.

The authors suggest that voluntary screening in emergency departments could address gaps in health care, particularly among people who are pregnant, have a high incidence of syphilis, or do not receive routine medical care. This study was conducted by the University of Chicago's Sections of Emergency Medicine and Infectious Diseases and Global Health with funding provided by the NIH's National Institute of Allergy and Infectious Diseases.

ARTICLE :

Stanford The et allAn emergency department screening intervention that allows patients to opt out leads to a significant increase in syphilis diagnosis. Open Forum on Infectious Diseases DOI: 10.1093/ofid/ofae490/7743295 (2024).

WHO:

Carolyn Deal, Ph.D., is the chief of the Enteric and Sexually Transmitted Infections Branch in the Division of Microbiology and Infectious Diseases at NIAID. She is available to discuss this work.

NIAID supports and conducts research at NIH and throughout the United States and around the world to study and develop new methods for diagnosing, preventing, and treating infectious and immune-mediated diseases. On the NIAID website, you can find news releases, fact sheets, and other NIAID materials. NIAID website.

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