Syphilis Screening in Pregnancy During Emergency Department Gonorrhea and Chlamydia Testing.
6 affiliations
- 1Cleveland Clinic, Department of Emergency Medicine Main Campus, Cleveland, Ohio.
- 2Cleveland Clinic, Center for Populations Health Research Quantitative Health Sciences, Cleveland, Ohio.
- 3Cleveland Clinic, Department of Pharmacy, Cleveland, Ohio.
- 4Cleveland Clinic, Women's Health Institute, Cleveland, Ohio.
- 5Cleveland Clinic, Diagnostics Institute, Pathology and Laboratory Medicine Department, Cleveland, Ohio.
- 6Cleveland Clinic, Section of Pediatric Infectious Diseases, Cleveland, Ohio.
Abstract
Introduction
Congenital syphilis is rising in the United States, especially among infants born to women with limited prenatal care. Emergency departments (ED) offer opportunities for early detection, particularly among patients evaluated for urogenital sexually transmitted infection (STI) concerns. In October 2019, our health system implemented an ED STI order set that promoted HIV co-testing and included a preselected option for syphilis testing. In this study, we evaluated change in syphilis testing during the post-implementation period among ED encounters with both pregnancy and gonorrhea/chlamydia (GC/CT) testing.Methods
We conducted a retrospective, quasi-experimental study across 20 EDs, using health record data from 2018 to 2023 for patients aged 15-44 years who received both pregnancy and GC/CT testing. We measured annual syphilis and HIV testing and positivity, stratified by pregnancy status. The primary study outcome was syphilis testing during the encounter; HIV testing and detection outcomes were secondary.Results
Among 59,171 ED encounters with pregnancy and GC/CT testing, 5,178 (8.8%) involved pregnant patients, and 9,538 (16.1%) received syphilis testing. Syphilis testing among pregnant patients increased from .9% in 2018 to 46.1% in 2023 (+45.1 percentage points [95% CI, 40.4-49.6]). Testing among nonpregnant patients rose from 1.2% to 35.9% (+34.6 percentage points [95% CI, 33.3-35.9]). Overall, only 1,068 of 5,178 pregnant encounters received a syphilis test (20.6%). Among 1,068 syphilis-tested pregnant encounters, 15 (1.4%) were treponemal-positive and 9 (.8%; 843 per 100,000 tested) met the Centers for Disease Control and Prevention surveillance definition for active syphilis (approximately 1 per 119 tests). Using all pregnant encounters with GC/CT testing as the denominator, the encounter-based active syphilis rate was 173.8 per 100,000 (.17%). HIV testing increased similarly (pregnant: .4% in 2018 to 44.5% in 2023), while HIV positivity remained rare (2 pregnant; 13 overall).Conclusion
Syphilis testing and case detection increased during the postimplementation period following introduction of a preselected STI order set in the electronic health record. Many encounters in the analytic cohort still did not include syphilis testing. These findings support the ED as an important setting for identifying syphilis in pregnancy while underscoring the need for further work to understand remaining testing gaps.
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BibTeX
@article{phelan2026syphilis,
title = {{Syphilis Screening in Pregnancy During Emergency Department Gonorrhea and Chlamydia Testing.}},
author = {Michael P Phelan and Elizabeth N Dewey and Fredric M Hustey and Stephen W Meldon and McKinsey Muir and Janet Wu and Matthew J Campbell and Oluwatosin Goje and Kamran Kadkhoda and Charles B Foster},
journal = {The western journal of emergency medicine},
year = {2026},
month = sep,
doi = {10.5811/westjem.54849},
url = {https://europepmc.org/article/MED/42900950},
note = {CC BY},
}
RIS
TY - JOUR
TI - Syphilis Screening in Pregnancy During Emergency Department Gonorrhea and Chlamydia Testing.
AU - Michael P Phelan
AU - Elizabeth N Dewey
AU - Fredric M Hustey
AU - Stephen W Meldon
AU - McKinsey Muir
AU - Janet Wu
AU - Matthew J Campbell
AU - Oluwatosin Goje
AU - Kamran Kadkhoda
AU - Charles B Foster
PY - 2026
DA - 2026/09/24
JO - The western journal of emergency medicine
DO - 10.5811/westjem.54849
UR - https://europepmc.org/article/MED/42900950
AB - Introduction Congenital syphilis is rising in the United States, especially among infants born to women with limited prenatal care. Emergency departments (ED) offer opportunities for early detection, particularly among patients evaluated for urogenital sexually transmitted infection (STI) concerns. In October 2019, our health system implemented an ED STI order set that promoted HIV co-testing and included a preselected option for syphilis testing. In this study, we evaluated change in syphilis testing during the post-implementation period among ED encounters with both pregnancy and gonorrhea/chlamydia (GC/CT) testing.Methods We conducted a retrospective, quasi-experimental study across 20 EDs, using health record data from 2018 to 2023 for patients aged 15-44 years who received both pregnancy and GC/CT testing. We measured annual syphilis and HIV testing and positivity, stratified by pregnancy status. The primary study outcome was syphilis testing during the encounter; HIV testing and detection outcomes were secondary.Results Among 59,171 ED encounters with pregnancy and GC/CT testing, 5,178 (8.8%) involved pregnant patients, and 9,538 (16.1%) received syphilis testing. Syphilis testing among pregnant patients increased from .9% in 2018 to 46.1% in 2023 (+45.1 percentage points [95% CI, 40.4-49.6]). Testing among nonpregnant patients rose from 1.2% to 35.9% (+34.6 percentage points [95% CI, 33.3-35.9]). Overall, only 1,068 of 5,178 pregnant encounters received a syphilis test (20.6%). Among 1,068 syphilis-tested pregnant encounters, 15 (1.4%) were treponemal-positive and 9 (.8%; 843 per 100,000 tested) met the Centers for Disease Control and Prevention surveillance definition for active syphilis (approximately 1 per 119 tests). Using all pregnant encounters with GC/CT testing as the denominator, the encounter-based active syphilis rate was 173.8 per 100,000 (.17%). HIV testing increased similarly (pregnant: .4% in 2018 to 44.5% in 2023), while HIV positivity remained rare (2 pregnant; 13 overall).Conclusion Syphilis testing and case detection increased during the postimplementation period following introduction of a preselected STI order set in the electronic health record. Many encounters in the analytic cohort still did not include syphilis testing. These findings support the ED as an important setting for identifying syphilis in pregnancy while underscoring the need for further work to understand remaining testing gaps.
SN - 1936-900X
SN - 1936-9018
ER -