(PL10) MISSED OPPORTUNITIES FOR DIAGNOSIS OF SYPHILIS IN THE EMERGENCY DEPARTMENT

Background:
Syphilis causes serious health problems if left untreated, requiring improved access to screening and treatment. Emergency departments (EDs) are an ideal screening site as they serve high-risk, underserved populations. This study identified missed opportunities (MOs) in the detection of syphilis and characteristics associated with experiencing a MO.

Methods:
IRB-approved retrospective study assessed patients (13+) screened for sexually transmitted infections (STIs), including chlamydia, trichomoniasis, or gonorrhea in six EDs between January 1ST 2018 and March 31st 2024. Syphilis diagnosis occurred with a reactive T. pallidum antibody screen and a reactive rapid plasma regain test. Positive syphilis test with no previous history of syphilis was designated newly diagnosed syphilis. MO occurred if a newly diagnosed syphilis received STI testing at another ED incident without being tested for syphilis. Unadjusted logistic regression assessed the association between sociodemographic characteristics and MO. Complete dataset was obtained and analyzed June 2024.

Results:
Of 38,398 patients screened for STIs during the study period, 3,949 (10.3%) were screened for syphilis. Of those, 121 (3.1%) had a history of syphilis, 200 (5.1%) were positive for syphilis, and 148 (3.8%) were new syphilis positives. Strikingly, 30 (20.4%) of new positive syphilis cases experienced a MO; 19 (63.3%) had one and 11 (36.7%) had ≥ two. Individuals with a MO were significantly younger than those without (30.1 vs. 36.1, p=0.0023). Females were nearly twice as likely to experience an MO (OR=1.95 95%CI=0.51-4.45, p= 0.1144) and those tested in a rural ED had double the odds of experiencing an MO (OR=2.07, 95%CI=0.58-5.653, p= 0.1560), however neither met statistical significance.

Conclusion:
One of every 5 newly diagnosed syphilis patients had a MO for syphilis diagnosis within the ED. Future research is needed to determine the demographic, operational, and clinical characteristics which predict a MO to better inform initiatives to increase testing.