Universal opt-out syphilis screening in a UK emergency department

The incidence of syphilis in several areas of England has risen substantially. National programmes for blood-borne viruses (BBV) screening in emergency departments (ED) have been ongoing for several years however have not included syphilis. We hypothesised that screening for syphilis in an ED in a region of high prevalence might identify significant numbers of cases.

Universal opt-out syphilis screening was included with BBVs in a Northeast England ED, where a regional outbreak is ongoing. Those with reactive tests were invited to sexual health service (SHS) for further evaluation.

Of 3312 ED attenders having blood drawn, 38 (1.2%) were confirmed T. pallidum EIA positive (45% RPR-positive). Compared to ED attenders testing negative, those with positive tests were younger and lived in more deprived areas, however had similar gender and ethnicity. 71% of those identified as needing assessment were seen in the SHS and 59% treated.

Universal screening for syphilis appears effective in identifying people with syphilis who traditionally don't access SHS. This population has different demographics to people with syphilis attending SHS in England, being predominantly heterosexual and equal proportions of women. Routine ED screening for syphilis along with BBVs may be warranted in areas of high transmission.