(PL9) EARLY SUCCESSES FROM AN OPT-OUT SYPHILIS SCREENING PROGRAM IN PERSONS OF REPRODUCTIVE POTENTIAL PRESENTING TO LOS ANGELES COUNTY EMERGENCY DEPARTMENTS, 2024

Background:
Since 2012, the syphilis epidemic among people of reproductive potential (PRP) in those assigned female sex at birth, aged 15-44 and congenital syphilis has continued to rise in Los Angeles County (LAC). Many of the syphilis cases among PRP experience housing instability, have concurrent substance use, and are not engaged in regular health care services.  To increase early identification of syphilis among PRP, LAC Department of Health Services (DHS) collaborated with LAC Department of Public Health (DPH) to establish an opt-out testing program for PRP seen in the emergency departments (EDs) of three large DHS safety-net hospitals.

Methods:
PRP seen in the EDs who had a blood draw were automatically ordered to have syphilis serologic testing. Frequency of ED visits and frequency with which patients did not opt out of syphilis testing was assessed. A descriptive analysis using PRP patient data, testing data, and public health surveillance data was conducted to report prevalence of new syphilis cases based on syphilis seropositivity.

Results:
Between January 9 and May 24, 2024, 7,948 unique PRP seen were included in the analysis. 6,143 (77%) were tested for syphilis of which 240 (4%) were seropositive. Of these, 136 (57%) were either a new syphilis case (N=119) or were an inadequately treated, previously identified case (N=17). Among the 119 new cases, 95 (80%) were first identified by the ED screening, while the remaining 24 cases had been identified by another facility in the 90 days prior to their ED visit. We estimate a 2.2 % prevalence of new or previously untreated syphilis among those tested, which is notably higher than the overall syphilis prevalence of 0.1% among PRP in LAC in 2023.

Conclusion:
Syphilis screening in EDs is an effective strategy to identify syphilis cases among PRP who may not be tested in other settings.