title: Factors associated with repeat syphilis testing at a large urban LGBT health clinic: Chicago, IL 2002-2008.
abstract: BACKGROUND
  The Centers for Disease Control and Prevention (CDC) recommends clinical and serologic re-evaluation at 6 and 12 months after diagnosis with early syphilis, to determine treatment efficacy.
  
  
  METHODS
  This was a retrospective cohort study of men who have sex with men enrolled in primary care at a lesbian, gay, bisexual, and transgender health center. We used multivariable Poisson regression to examine associations between patient characteristics and timely follow-up (return clinic visit within 6 months of initial diagnosis) and among patients with timely follow-up, factors associated with rescreening at the follow-up visit.
  
  
  RESULTS
  January 2002 through December 2008, 5788 tests for syphilis were performed; 256 (4.4%) cases of early syphilis were detected among 225 men. Of 225 134 (59.6%) had timely follow-up. After implementation of electronic medical records and enhanced DIS follow-up, timely follow-up increased from 53% to 76% and rescreening increased from 64% to 81%. HIV-positive men were more likely to have timely follow-up (adjusted relative risk [aRR]=1.93; 95% CI: 1.31-2.85), as were patients diagnosed 2007-2008 (aRR=1.28; 95% CI: 1.04-1.57). Among patients with timely follow-up, 94 (70%) were rescreened for syphilis. Diagnosis in 2007-2008 was associated with a greater likelihood that the patient was rescreened at the follow-up visit (aRR=1.24; 95% CI: 1.00-1.53).
  
  
  CONCLUSIONS
  Timely follow-up and rescreening improved during the study period, subsequent to implementation of electronic medical records and enhanced DIS follow-up. Even in this later period, the combination of lack of timely follow-up and rescreening resulted in 39% of patients without CDC recommended follow-up. Further efforts are needed to improve timely follow-up by patients and rescreening by clinicians.
authors.affiliation: Department of HIV/STD Prevention, Howard Brown Health Center, Chicago, IL 60613, USA. annah@howardbrown.org
authors.forename: Anna L
authors.initials: AL
authors.lastname: Hotton
authors.forename: Beau
authors.initials: B
authors.lastname: Gratzer
authors.forename: Daniel
authors.initials: D
authors.lastname: Pohl
authors.forename: Supriya D
authors.initials: SD
authors.lastname: Mehta
mesh_terms: D000328:Adult; D000368:Aged; D001727:Bisexuality; D002641:Chicago; D057286:Electronic Health Records; D005500:Follow-Up Studies; D006679:HIV Seropositivity; D018451:Homosexuality, Male; D006801:Humans; D008297:Male; D008875:Middle Aged; D012044:Regression Analysis; D012189:Retrospective Studies; D013587:Syphilis / Q000175:diagnosis; D013592:Syphilis, Latent / Q000175:diagnosis*; D013997:Time Factors; D019037:Urban Health Services; D055815:Young Adult