Emergency department-based surveillance for syphilis during an outbreak in Philadelphia

Hibbs, Jonathan R.; Ceglowski, Walter S.; Goldberg, Martin; Kauffman, Frederic H.

doi:10.1016/s0196-0644(05)80108-8

Cited by 19 publications

(3 citation statements)

References 18 publications

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“…Furthermore, in the adolescent population, universal screening for STIs has been shown to be highly acceptable 15,16 . One previous study during a local outbreak of syphilis found rates of 2% to 4% in patients without STI-related complaints, 17 and similar rates were found during a small study that actively enrolled ED patients after determining behavioral risk factors 18 …”

Section: Discussionmentioning

confidence: 89%

Opt-Out, Routine Emergency Department Syphilis Screening as a Novel Intervention in At-Risk Populations

Stanford¹,

Hazra

Friedman

et al. 2020

Sexual Trans Dis

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Background: With syphilis rates rising rapidly in the United States, novel means of reaching high-risk populations for screening and treatment are needed. Building on successful models for emergency department (ED) HIV screening, a routine opt-out syphilis screening program was implemented in a large, urban, tertiary care hospital ED in May 2019. This study aims to assess the prevalence of syphilis in this population and to evaluate the routine, opt-out syphilis screening model.Methods: A retrospective chart review was performed of all patients screened for syphilis in the ED from June to December 2019. Demographic information, HIV status, chief complaint, and follow-up visits were examined.Results: During the study period, 9198 people aged 18 to 64 years were screened for syphilis. Of these, 97 (1.1%) had presumed active syphilis infection (PAI), 354 (3.8%) were presumed not to have active syphilis, and 8747 (95.1%) were negative for infection. Patients with PAI were more likely to be male (67%; adjusted odds ratio, 3.5; 95% confidence interval, 2.3-5.3; P < 0.001), although the percentage of women was considerably higher than the nationally reported rate, and most were non-Hispanic Black (93.8%). Among patients with PAI, 23 (23.7%) were HIV positive. Only 18.6% of patients with PAI presented with complaints related to sexually transmitted infections.Conclusions: Syphilis rates in this community are very high, and many infections were found in populations traditionally considered at lower risk by demographic or presenting complaint, indicating that universal screening is needed. Routine ED syphilis screening in high-prevalence communities will be critical to addressing the syphilis epidemic.

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Section: Discussionmentioning

confidence: 89%

Opt-Out, Routine Emergency Department Syphilis Screening as a Novel Intervention in At-Risk Populations

Stanford¹,

Hazra

Friedman

et al. 2020

Sexual Trans Dis

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“…However, early latent cases have often been included in local surveillance reports, program evaluations, and research studies, especially when there were relatively few cases of primary and secondary syphilis. [10][11][12][13][14][15][16][17][18][19][20][21][22][23][24][25][26][27] Rates of correctly classified early latent syphilis would help reflect syphilis incidence rates.…”

Section: Discussionmentioning

confidence: 99%

Misclassification of the Stages of Syphilis: Implications for Surveillance

Peterman

Kahn²,

Ciesielski³

et al. 2005

Sexually Transmitted Diseases

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“…Several ED STD screening programs have been financed and staffed by health departments, often in response to local outbreaks. 15 If health departments do not support screening, public or private insurers must pay. However, they may decline to pay for the many uninsured or underinsured ED 5 patients or those who have non-STDrelated complaints.…”

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confidence: 99%

Factors that Influence the Cost Effectiveness of Gonorrhea Screening in Emergency Departments

Gift

Irwin

2005

Sexually Transmitted Diseases

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SEXUALLY TRANSMITTED DISEASE (STD) prevalence among low-income emergency department (ED) patients is higher than that in many other health care settings. 1 Routine STD screening may offer clinical benefits to ED patients and may complement other STD control strategies in communities with high STD incidence. While gonorrhea prevalence among ED patients is typically lower than chlamydia prevalence, a greater proportion of patients with gonorrhea than chlamydial infection receive treatment in the ED. 2 In this issue, Aledort et al. 3 model various ED gonorrhea screening strategies for young, asymptomatic women with high prevalence. They found that screening would be a cost-effective alternative to not screening and that an investigational rapid immunochromotographic strip test (RIS) using self-collected vaginal swabs would offer advantages over endocervical Gram stains and nonrapid, nucleic acid amplification tests (NAAT) using urine or endocervical specimens. Although the sensitivity of RIS (Ͻ80% 3 ) is lower than the sensitivity of NAAT, RIS use would result in treating a higher proportion of test-positive patients than NAAT. RIS use would also prevent more cases of pelvic inflammatory disease (PID), and yield more quality-adjusted life years (QALYs). The RIS would not be cost saving compared to urinebased NAAT, but the incremental cost per QALY gained over NAAT would be less than many interventions considered cost effective. Also, the cost of RIS using clinician-collected specimens would be more than the urine-based NAAT, but the difference was minor (11% or less, depending on the age groups screened). Both NAAT and RIS would be superior in terms of cost and outcomes to the other rapid test considered, the Gram stain. This analysis is consistent with another study showing that gonorrhea and chlamydia screening of women with urine-based NAAT in a Baltimore ED with high gonorrhea and chlamydia prevalence was cost saving compared to no screening. 4 This intriguing analysis of an investigational rapid test should prompt decision makers to address the clinical, operational, and economic barriers that have stalled routine STD screening in most ED. 1 First, STDs are not a priority for most EDs patients. Only 3.4% of ED visits in 2002 were primarily motivated by genitourinary symptoms. 5 Most gonorrhea infections in women are asymptomatic, 6,7 and no evidence suggests that women will request screening in the absence of symptoms. Most ED clinicians are urged to manage symptomatic conditions during their brief encounters and to refer patients elsewhere for preventive services such as screening.Second, logistic barriers have precluded routine STD screening using endocervical specimens. Most EDs lack enough gynecologic examination facilities or skilled examiners to routinely collect endocervical specimens, and patients without genitourinary complaints may decline speculum examinations. Here, self-collected vaginal specimens provide logistic advantages and would reduce demand on clinician time. Given the typical length of ED ...

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Emergency department-based surveillance for syphilis during an outbreak in Philadelphia

Cited by 19 publications

References 18 publications

Opt-Out, Routine Emergency Department Syphilis Screening as a Novel Intervention in At-Risk Populations

Opt-Out, Routine Emergency Department Syphilis Screening as a Novel Intervention in At-Risk Populations

Misclassification of the Stages of Syphilis: Implications for Surveillance

Factors that Influence the Cost Effectiveness of Gonorrhea Screening in Emergency Departments

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