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P740 Improving syphilis diagnosis and treatment in an urban population through routine emergency department screening
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  1. Kimberly Stanford,
  2. Jessica Ridgway,
  3. John Schneider
  1. University of Chicago, Medicine, Chicago, USA

Abstract

Background With the recent nationwide increase in syphilis, it is imperative to find novel means of reaching at-risk populations for early diagnosis and treatment. Many urban communities have both high rates of syphilis and frequently utilize the emergency department (ED) as a primary source of medical care. In late 2018, the University of Chicago Medical Center (UCMC) began a quality improvement project directing providers to screen ED patients for syphilis regardless of presenting complaint. The objective of this study is to evaluate the potential utility of ED screening for syphilis.

Methods A retrospective chart review was performed of all patients with positive syphilis antibody testing from October through December of 2018, and all patients with positive rapid plasma reagin (RPR) or Treponema pallidum particle agglutination (TP-PA) testing were included as cases.

Results In the last three months of 2018, a total of 727 patients (average of 242 patients per month) were screened for syphilis in the ED. Of these, 61 (8.4%) tested positive for syphilis, 37 (60.1%) of whom had evidence of active infection, and 24 (39.3%) were late or unknown stage. 40.9% of patients testing positive for syphilis had presented with complaints other than abdominal pain, rash, or genitourinary symptoms. Two (3%) of patients testing positive for syphilis were also newly found to be pregnant and both were referred for antibiotic treatment in the first trimester.

Conclusion Early data suggests that screening of patients for syphilis in the ED regardless of presenting complaint yields high positive rates. ED screening may represent an effective way of combating the syphilis epidemic, particularly in the most vulnerable populations. In the near future, we plan to hold a provider awareness initiative combined with an update to the electronic medical record system with automated ordering reminders to increase the numbers of patients screened.

Disclosure No significant relationships.

  • syphilis
  • diagnosis
  • prevention
  • intervention and treatment

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