title: Emergency department-based surveillance for syphilis during an outbreak in Philadelphia.
abstract: OBJECTIVE
  To identify missed opportunities for syphilis treatment during an outbreak.
  
  
  METHODS
  Prospective prevalence survey.
  
  
  METHODS
  Urban hospital emergency department.
  
  
  METHODS
  Nine hundred sixty-one persons aged 15 to 44 years seeking medical attention in the ED who were not suspected of having any sexually transmitted disease (STD) at the time of their visit.
  
  
  METHODS
  Serologic testing for syphilis and public health follow-up as needed.
  
  
  RESULTS
  Twenty-one non-STD patients (2%) had untreated early syphilis, and 22 (2%) had positive serology but were lost to follow-up. Among 271 STD patients seen in the ED during the same period, 15 cases (6%) were detected. We estimate that 80 or more additional untreated early syphilis cases would have been identified had all 15- to 44-year-old patients entering the ED been tested. The cost of screening was $251 per case detected.
  
  
  CONCLUSIONS
  Patients not suspected of having any STD account for most early syphilis cases among all ED patients. Screening and on-site treatment for syphilis should be offered to all young adults seeking medical attention in the ED during syphilis outbreaks.
authors.affiliation: Division of Field Services, Centers for Disease Control, Atlanta, Georgia.
authors.forename: J R
authors.initials: JR
authors.lastname: Hibbs
authors.forename: W S
authors.initials: WS
authors.lastname: Ceglowski
authors.forename: M
authors.initials: M
authors.lastname: Goldberg
authors.forename: F
authors.initials: F
authors.lastname: Kauffman
mesh_terms: D000293:Adolescent; D000328:Adult; D004196:Disease Outbreaks; D004636:Emergency Service, Hospital; D005260:Female; D006801:Humans; D008297:Male; D015143:Philadelphia; D011159:Population Surveillance; D011446:Prospective Studies; D013587:Syphilis / Q000175:diagnosis / Q000453:epidemiology*