Emergency department screening for syphilis in pregnant women without prenatal care.
OBJECTIVE
To determine if there is a high seroprevalence of syphilis in pregnant women without prenatal care presenting to an urban emergency department.


METHODS
Prospective, nonblinded sampling of pregnant women without prenatal care with a comparison group of pregnant women with prenatal care from the obstetrics clinic. Patients in the ED setting were asked about such associated risk factors as previous syphilis and drug use.


METHODS
Urban ED.


METHODS
Pregnant women without prenatal care.


METHODS
Patients were screened for syphilis using the automated reagin test. Reactive automated reagin tests were confirmed by the fluorescent treponemal antibody absorption. In addition, 44 patients with nonreactive automated reagin tests had confirmatory tests done. New cases were verified by the state health department.


RESULTS
Seventy-two patients were included in the study. The average age was 25 years. Eight patients (11.1%) were diagnosed with previously undetected syphilis. Four patients (5.6%) had previously treated syphilis. The laboratory cost of screening was $248 per new case of syphilis detected. The study group was compared with 118 patients matched for age and race who presented to the obstetrics clinic for routine prenatal care. Two new cases of syphilis were discovered in the clinic population (1.7%).


CONCLUSIONS
A high rate of syphilis infection was detected in this inner-city ED population presenting without prenatal care. This was higher than that found in the patients presenting for obstetrics care in the clinic. Patients can be screened effectively in the ED.
Ernst
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AA
Department of Medicine, Louisiana State University, New Orleans.
Romolo
R
R
Nick
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T
D000328:Adult; D004636:Emergency Service, Hospital; D005260:Female; D006801:Humans; D011247:Pregnancy; D011251:Pregnancy Complications, Infectious / Q000175:diagnosis* / Q000453:epidemiology; D011295:Prenatal Care; D011446:Prospective Studies; D016036:Seroepidemiologic Studies; D013587:Syphilis / Q000175:diagnosis* / Q000453:epidemiology; D014505:Urban Population