title: Low rate of syphilis screening among high-risk emergency department patients tested for gonorrhea and chlamydia infections.
abstract: BACKGROUND
  Implementing national recommendations for syphilis screening is not feasible in the emergency department (ED) setting. The purpose of this study was to determine the syphilis screening rate among ED patients tested for gonorrhea and chlamydia (GC/CT) and the syphilis prevalence among those who were tested.
  
  
  METHODS
  A 1-year retrospective cohort study in an urban ED. At the time of this study, there were no explicit syphilis screening guidelines and testing was at the discretion of the treating physician. We determined the proportion of all GC/CT-tested patients who also underwent syphilis screening and the prevalence of syphilis among this group. Predictors of syphilis screening among patients tested for GC/CT were identified.
  
  
  RESULTS
  GC/CT tests were performed in 3951 (4.7%) of the 83,988 ED visits, of which 332 (8.4%) were reactive. The mean age of GC/CT-tested patients was 22.6 ± 12 years, most were female (67%), black (47%), and English speaking (74%). Syphilis screening was completed in 1218 (31%) of the GC/CT-tested patients, 17 tests (1.4%) were reactive, which included 8 (0.7%) unique patients with newly diagnosed syphilis. In multivariable analysis, the following variables were predictive of syphilis screening: empirical GC/CT treatment (odds ratio [OR]: 1.9, 95% confidence interval [CI]: 1.6-2.3), evaluation in the low acuity section of the ED (OR: 1.8, 95% CI: 1.4-2.3), a reactive GC/CT test (OR: 1.3, 95% CI: 1.0-1.6), and age ≤25 years (OR: 1.2, 95% CI: 1.0-1.4).
  
  
  CONCLUSIONS
  Among ED patients tested for GC/CT, less than one-third were screened for syphilis. Failure to screen these patients likely resulted in missed opportunities for syphilis diagnosis.
authors.affiliation: Department of Emergency Medicine, Alameda County Medical Center, Highland Hospital, Oakland, CA 94607, USA. daewhite@gmail.com
authors.forename: Douglas A E
authors.initials: DA
authors.lastname: White
authors.forename: Harrison J
authors.initials: HJ
authors.lastname: Alter
authors.forename: Nathan A
authors.initials: NA
authors.lastname: Irvin
authors.forename: Melissa C
authors.initials: MC
authors.lastname: Clark
authors.forename: Bradley W
authors.initials: BW
authors.lastname: Frazee
mesh_terms: D000293:Adolescent; D000328:Adult; D002140:California / Q000453:epidemiology; D002648:Child; D002690:Chlamydia Infections / Q000175:diagnosis* / Q000453:epidemiology; D015331:Cohort Studies; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data; D005260:Female; D006069:Gonorrhea / Q000175:diagnosis* / Q000453:epidemiology; D006801:Humans; D008297:Male; D008403:Mass Screening / Q000706:statistics & numerical data*; D015999:Multivariate Analysis; D010865:Pilot Projects; D015995:Prevalence; D012189:Retrospective Studies; D018570:Risk Assessment; D013587:Syphilis / Q000175:diagnosis* / Q000453:epidemiology / Q000235:genetics; D014505:Urban Population; D055815:Young Adult