Gaps in syphilis screening for patients receiving sexually transmitted infection testing in the emergency department

To assess gaps in emergency department (ED) syphilis screening in patients receiving testing for other sexually transmitted infections (STI) within a large healthcare system in Upstate South Carolina (SC).

A retrospective cohort study of patients (aged 13+) tested for STIs (gonorrhea, chlamydia, or trichomonas) across eight EDs from 1/1/2020-12/31/2024 was examined. A missed opportunity (MO) for syphilis screening was defined as absent syphilis screening during any ED encounter where STI testing obtained. Adjusted logistic regression identified characteristics associated with a MO for syphilis screening.

Between 2020 and 2024 syphilis screening increased by 127.1%, occurring in 9.9% of all encounters. Patients were less likely to have a MO if they were aged 13-19 years compared to 30-34 years (aOR = 0.89, 95%CI = 0.77-1.02), attended an ED with an opt-out screening program (aOR = 0.84, 95%CI = 0.78-0.91) or had a history of any STI (aOR = 0.80, 95%CI = 0.71-0.91). Individuals were more likely to have an MO if they were female (aOR = 1.82, 95%CI = 1.65-2.00) uninsured (aOR = 1.17, 95%CI = 1.07-1.28), had one STI screen (aOR = 3.47, 95%CI = 2.95-4.09) or two STI screens (aOR = 1.19, 95%CI = 1.09-1.31) compared to three STI screens, and had no previous history of HIV (aOR = 1.77, 95%CI = 1.26-2.47) or syphilis (aOR = 2.82, 95%CI = 2.13-3.74).

Notable gaps exist in ED syphilis screening within patients receiving testing for other STIs. Adopting ED syphilis screening initiatives is urgently necessary to expand screening in high-risk geographic areas as recommended by the CDC.