EMERGENCY DEPARTMENT-BASED SURVEILLANCE FOR SYPHILIS DURING AN OUTBREAK IN PHILADELPHIA

Study objective: To identify missed opportunities for syphilis treatment during an outbreak. Design: Prospective prevalence survey. Setting: Urban hospital emergency department. Participants: Nine hundred sixty-one persons aged 15 to 44 years seeking medical attention in the ED who were not suspected of having any sexually transmitted disease (STD) at the time of their visit. Intervention: Serologic testing for syphilis and public health follow-up as needed. Measurements and main results: Twenty-one non-STD patients (2%) had untreated early syphilis, and 22 (2%) had positive serology but were lost to follow-up. Among 271 STD patients seen in the ED during the same period, 15 cases (6%) were detected. We estimate that 80 or more additional untreated early syphilis cases would have been identified had all 15- to 44-year-old patients entering the ED been tested. The cost of screening was $251 per case detected. Conclusion: Patients not suspected of having any STD account for most early syphilis cases among all ED patients. Screening and on-site treatment for syphilis should be offered to all young adults seeking medical attention in the ED during syphilis outbreaks.