A Potential Screening Strategy to Identify Probable Syphilis Infections in the Urban Emergency Department Setting

Author:

Hunt Joanne H1ORCID,Laeyendecker Oliver1ORCID,Rothman Richard E2ORCID,Fernandez Reinaldo E3ORCID,Dashler Gaby2,Caturegli Patrizio4ORCID,Hansoti Bhakti2ORCID,Quinn Thomas C134,Hsieh Yu-Hsiang2ORCID

Affiliation:

1. Laboratory of Immunoregulation, National Institute of Allergy and Infectious Diseases, National Institutes of Health , Bethesda, Maryland , USA

2. Department of Emergency Medicine, School of Medicine, Johns Hopkins University , Baltimore, Maryland , USA

3. Division of Infectious Diseases, Department of Medicine, Johns Hopkins University School of Medicine , Baltimore, Maryland , USA

4. Department of Pathology, Johns Hopkins University School of Medicine , Baltimore, Maryland , USA

Abstract

Abstract Background Syphilis diagnosis in the emergency department (ED) setting is often missed due to the lack of ED-specific testing strategies. We characterized ED patients with high-titer syphilis infections (HTSIs) with the goal of defining a screening strategy that most parsimoniously identifies undiagnosed, untreated syphilis infections. Methods Unlinked, de-identified remnant serum samples from patients attending an urban ED, between 10 January and 9 February 2022, were tested using a three-tier testing algorithm, and sociodemographic variables were extracted from ED administrative database prior to testing. Patients who tested positive for treponemal antibodies in the first tier and positive at high titer (≥1:8) for nontreponemal antibodies in the second tier were classified as HTSI. Human immunodeficiency virus (HIV) status was determined with Bio-Rad enzyme-linked immunosorbent assay and confirmatory assays. Exact logistic regression and classification and regression tree (CART) analyses were performed to determine factors associated with HTSI and derive screening strategies. Results Among 1951 unique patients tested, 23 (1.2% [95% confidence interval, .8%–1.8%]) had HTSI. Of those, 18 (78%) lacked a primary care physician, 5 (22%) were HIV positive, and 8 (35%) were women of reproductive age (18–49 years). CART analysis (area under the curve of 0.67) showed that using a screening strategy that measured syphilis antibodies in patients with HIV, without a primary care physician, and women of reproductive age would have identified most patients with HTSI (21/23 [91%]). Conclusions We show a high prevalence of HTSI in an urban ED and propose a feasible, novel screening strategy to curtail community transmission and prevent long-term complications.

Funder

Division of Intramural Research

National Institute of Allergy and Infectious Diseases

National Institutes of Health

Publisher

Oxford University Press (OUP)

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