Universal syphilis screening in ED ‘best bet’ for identifying cases
Key takeaways:
- A universal syphilis screening program implemented in an ED successfully identified cases that would have otherwise been missed.
- Targeting specific populations for testing could lead to missed cases.
SAN FRANCISCO — A universal syphilis screening program identified more cases of syphilis than programs targeting specific patient populations, such as pregnant women and patients already receiving blood draws, researchers found.
“As syphilis numbers have been rising, we have been realizing that people who are highly or more at risk for syphilis often are not accessing the health care system in the usual places that we’ve traditionally screened them. We’re finding that if they have limited access to health care, they’re often going to the emergency department for their care,” Kimberly A. Stanford, MD, MPH, associate professor of medicine at the University of Chicago, said during a press conference at the Conference on Retroviruses and Opportunistic Infections (CROI).
“As a result, screening programs in the ED have been getting increasing attention over the last few years,” she said.
In 2019, Standford and colleagues implemented a universal opt-out ED syphilis screening program. At the 2024 CROI meeting, Stanford presented retrospectively gathered data which assessed the impact of the program by comparing 2 years before the program with 2 years after its implementation.
Data showed that in the 2 years before the intervention, 6.2% of encounters included testing for syphilis. This increased nearly eightfold after the intervention to 52.4%. More cases of syphilis were also identified after the intervention (three vs. 16).
“There’s been a lot of debate nationally about whether [a universal screening program] makes sense,” Stanford said. “Does it make sense to screen everybody, or should we be targeting certain groups? A lot of HIV screening programs are tied to someone ... already having a blood draw. So, we just ignore the folks that aren’t getting their blood drawn already? Or do we think about who is our at-risk population? Do we target this towards people who are reproductive potential? Do we target this towards people who are already pregnant?”
To assess if a more targeted screening program would be successful, Stanford and colleagues retrospectively reviewed who was screened in the universal program and assessed the number of patients that would have been missed if only specifically targeted populations were tested. Groups targeted in the study included people being tested for gonorrhea or chlamydia, women of reproductive age, anyone receiving a blood draw and anyone receiving a complete blood count.
In total, 37,289 people were screened for syphilis, of whom 624 (1.7%) were deemed active syphilis cases. The study revealed that had syphilis screening been conducted only in those patients receiving gonorrhea or chlamydia testing, only 147 cases would have been identified (23.6% sensitivity), whereas screening only women of reproductive age would have identified 142 cases (22.8% sensitivity). Further, screening only those receiving complete blood counts would have identified 472 cases (75.6% sensitivity).
The highest sensitivity was observed when screening was targeted to patients undergoing unrelated blood draws, which identified 516 cases (82.7% sensitivity). Stanford said targeting patients already receiving blood draws does have “practical aspects,” but it still missed “a fair number” of patients.
“The bottom line is, if you’re in a high prevalence area and you’re running an ED screening program — which I think everybody should be — universal screening probably is going to be your best bet until we start to get this epidemic under control,” Stanford said.
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Stanford K, et al. Abstract 160. Presented at: Conference on Retroviruses and Opportunistic Infections; March 9-12, 2025; San Francisco.
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