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Menza TW, Berry SA, Dombrowski JC, Cachay E, Crane HM, Mayer KH. Estimating the Proportion of People Living With HIV Who May Benefit From the Reverse Algorithm for the Diagnosis of Incident Syphilis. Sex Transm Dis 2024; 51:e26-e29. [PMID: 38733975 PMCID: PMC11090411 DOI: 10.1097/olq.0000000000001955] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/13/2024]
Abstract
ABSTRACT Among 8455 people engaged in HIV care in 4 US cities, 4925 (58%) had treponemal testing at care entry. Of the 4925 tested, 3795 (77%) had a nonreactive result and might benefit from the reverse algorithm for a future incident syphilis diagnosis. Furthermore, low-barrier treponemal testing as a first step in the reverse algorithm may increase syphilis screening and decrease time to treatment.
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Affiliation(s)
- Timothy W. Menza
- Oregon Health and Science University, Portland, Oregon, USA
- Oregon Health Authority, Portland, Oregon, USA
| | | | | | - Edward Cachay
- University of California – San Diego School of Medicine, San Diego, CA, USA
| | - Heidi M. Crane
- University of Washington School of Medicine, Seattle, WA, USA
| | - Kenneth H. Mayer
- Harvard Medical School, Boston, MA, USA
- Fenway Community Health Center, Boston, MA, USA
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2
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Scott K, Faryar KA, Patil N, Gripshover B, Hammond C, Purohit M, Schmotzer C, Suleman-Civis L, Niforatos J, Avery A, Yax J. Evaluation of an emergency department opt-out provider-driven HIV and syphilis screening and linkage-to-care program. Am J Emerg Med 2024; 77:187-193. [PMID: 38163414 DOI: 10.1016/j.ajem.2023.12.029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2023] [Revised: 12/13/2023] [Accepted: 12/14/2023] [Indexed: 01/03/2024] Open
Abstract
OBJECTIVE While the effectiveness of emergency departments (ED) in screening for HIV and syphilis is understood, less is known about dual screening programs. We aim to evaluate the impact of an opt-out provider-initiated HIV and syphilis program on screening, diagnosis, and linkage to care outcomes. METHODS We performed a retrospective review of patients screened pre (2014-2017) and post (2017-2021) program implementation. Primary outcomes include HIV and syphilis screening, incidence of positive tests, and proportion of patients linked to care. Secondary outcomes included pre-exposure prophylaxis (PrEP) referral and successful linkage rates for HIV-negative syphilis-positive patients. RESULTS Pre-implementation, 882 HIV tests were performed, of which 22 (2.49%) were new cases and 18 (81.82%) were linked to care; 754 syphilis tests were performed, of which 33 (4.38%) were active infections and 30 (90.91%) were treated. No eligible patients received PrEP referral. Post-implementation, 12,999 HIV tests were performed, of which 73 (0.56%) were new cases and 55 (75.34%) were linked to care; 10,885 syphilis tests were performed, of which 216 (1.98%) were active infections and 188 (87.04%) were treated. 25 (9.09%) eligible patients were referred for PrEP, and four (16.0%) attended their appointment. CONCLUSIONS Post-implementation, there was a 1373.81% and 1343.63% increase in screening, and a 231.82% and 554.55% increase in positive cases of HIV and syphilis, respectively. Dual screening programs can be successfully implemented within the existing ED framework to increase screening and early detection for HIV and syphilis.
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Affiliation(s)
- Kristal Scott
- Department of Emergency Medicine, University Hospitals, Cleveland, OH, USA.
| | - Kiran A Faryar
- Department of Emergency Medicine, University Hospitals, Cleveland, OH, USA
| | - Nirav Patil
- Clinical Research Center, University Hospitals, Cleveland, OH, USA
| | - Barbara Gripshover
- Department of Infectious Disease, University Hospitals, Cleveland, OH, USA
| | | | - Maulik Purohit
- University Hospitals Cleveland Medical Center, Cleveland, OH, USA
| | - Christine Schmotzer
- University Hospitals Cleveland Medical Center, Cleveland, OH, USA; Case Western Reserve University School of Medicine, Cleveland, OH, USA
| | | | - Joshua Niforatos
- Department of Emergency Medicine, University Hospitals, Cleveland, OH, USA; Case Western Reserve University School of Medicine, Cleveland, OH, USA
| | - Ann Avery
- MetroHealth Medical Center, Cleveland, OH, USA
| | - Justin Yax
- Department of Emergency Medicine, University Hospitals, Cleveland, OH, USA
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3
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Papp JR, Park IU, Fakile Y, Pereira L, Pillay A, Bolan GA. CDC Laboratory Recommendations for Syphilis Testing, United States, 2024. MMWR Recomm Rep 2024; 73:1-32. [PMID: 38319847 PMCID: PMC10849099 DOI: 10.15585/mmwr.rr7301a1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2024] Open
Abstract
This report provides new CDC recommendations for tests that can support a diagnosis of syphilis, including serologic testing and methods for the identification of the causative agent Treponema pallidum. These comprehensive recommendations are the first published by CDC on laboratory testing for syphilis, which has traditionally been based on serologic algorithms to detect a humoral immune response to T. pallidum. These tests can be divided into nontreponemal and treponemal tests depending on whether they detect antibodies that are broadly reactive to lipoidal antigens shared by both host and T. pallidum or antibodies specific to T. pallidum, respectively. Both types of tests must be used in conjunction to help distinguish between an untreated infection or a past infection that has been successfully treated. Newer serologic tests allow for laboratory automation but must be used in an algorithm, which also can involve older manual serologic tests. Direct detection of T. pallidum continues to evolve from microscopic examination of material from lesions for visualization of T. pallidum to molecular detection of the organism. Limited point-of-care tests for syphilis are available in the United States; increased availability of point-of-care tests that are sensitive and specific could facilitate expansion of screening programs and reduce the time from test result to treatment. These recommendations are intended for use by clinical laboratory directors, laboratory staff, clinicians, and disease control personnel who must choose among the multiple available testing methods, establish standard operating procedures for collecting and processing specimens, interpret test results for laboratory reporting, and counsel and treat patients. Future revisions to these recommendations will be based on new research or technologic advancements for syphilis clinical laboratory science.
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Ford JS, Rouleau SG, Wagner JL, Adams CB, May LS, Parikh AK, Holmes JF. Assessment of a COVID-19 vaccination protocol for unhoused patients in the emergency department. Vaccine 2023; 41:1611-1615. [PMID: 36732166 PMCID: PMC9805895 DOI: 10.1016/j.vaccine.2022.12.063] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2021] [Revised: 11/23/2022] [Accepted: 12/28/2022] [Indexed: 01/03/2023]
Abstract
BACKGROUND We aimed to evaluate the feasibility of implementing an emergency department (ED)-based Coronavirus Disease of 2019 (COVID-19) vaccination protocol in a population of unhoused patients. METHODS On June 10, 2021, a best practice alert (BPA) was implemented that fired when an ED provider opened the charts of unhoused patients and prompted the provider to order COVID-19 vaccination for eligible patients. We downloaded electronic medical record data of patients who received a COVID-19 vaccine in the ED between June 10, 2021 and August 26, 2021. The outcomes of interest were the number of unhoused, and the total number of patients vaccinated for COVID-19 during the study period. Data were described with simple descriptive statistics. RESULTS There were 25,871 patient encounters in 19,992 unique patients (mean 1.3 visits/patient) in the emergency department during the study period. There were 1,474 (6% of total ED population) visits in 1,085 unique patients who were unhoused (mean 1.4 visits/patient). The BPA fired in 1,046 unhoused patient encounters (71% of PEH encounters) and was accepted in 79 (8%). Forty-three unhoused patients were vaccinated as a result of the BPA (4% of BPA fires) and 18 unhoused patients were vaccinated without BPA prompting. An additional 76 domiciled patients were vaccinated in the ED. CONCLUSIONS Implementing an ED-based COVID-19 vaccination program is feasible, however, only a small number of patients underwent COVID-19 vaccination. Further studies are needed to explore the utility of using the ED as a setting for COVID-19 vaccination.
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Affiliation(s)
- James S Ford
- Department of Emergency Medicine, University of California Davis Health, Sacramento, CA, USA
| | - Sam G Rouleau
- Department of Emergency Medicine, University of California Davis Health, Sacramento, CA, USA
| | - Jenny L Wagner
- Department of Public Health Sciences, University of California Davis, Davis, CA, USA
| | - Christopher B Adams
- Department of Emergency Medicine, University of California Davis Health, Sacramento, CA, USA
| | - Larissa S May
- Department of Emergency Medicine, University of California Davis Health, Sacramento, CA, USA
| | - Aman K Parikh
- Department of Emergency Medicine, University of California Davis Health, Sacramento, CA, USA
| | - James F Holmes
- Department of Emergency Medicine, University of California Davis Health, Sacramento, CA, USA.
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Ford JS, Shevchyk I, Yoon J, Chechi T, Voong S, Tran N, May L. Risk Factors for Syphilis at a Large Urban Emergency Department. Sex Transm Dis 2022; 49:105-110. [PMID: 34471079 DOI: 10.1097/olq.0000000000001543] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND The prevalence of syphilis is increasing in the United States. The emergency department (ED) is an important setting to screen and treat underserved populations. To tailor testing protocols to the local population, we aimed to identify risk factors for syphilis positivity in ED patients. METHODS We performed a retrospective analysis of ED patients who were screened for syphilis between November 2018 and August 2020. Patients were screened for Treponema pallidum antibody using a multiplex flow immunoassay, and positive results were confirmed by rapid plasma reagin or T. pallidum particle agglutination. Risk factors for new syphilis diagnoses were identified using multiple logistic regression. RESULTS We screened 1974 patients for syphilis (mean age, 37 ± 16 years; 56% female). We identified 201 patients with new infections without previous treatment. Independent risk factors for a new diagnosis of syphilis included housing status (undomiciled, 23% [60 of 256]; domiciled, 9% [133 of 1559]; adjusted odds ratio [aOR], 1.9 [95% confidence interval {CI}, 1.2-3.0]), history of HIV (positive, 44% [28 of 63]; negative, 9% [173 of 1893]; aOR, 5.8 [95% CI, 3.0-11.2]), tobacco use (positive, 15% [117 of 797]; negative, 4% [29 of 665]; aOR, 2.4 [95% CI, 1.5-3.9]), and illicit drug use (positive, 14% [112 of 812]; negative, 8% [52 of 678]; aOR, 2.2 [95% CI, 1.0-2.5]). CONCLUSIONS Undomiciled housing status, history of HIV, history of tobacco use, and history of illicit drug use were independently associated with a new diagnosis of syphilis in the ED. Broadening targeted syphilis screening algorithms beyond sexually transmitted disease-related complaints could help identify new syphilis cases for treatment.
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Affiliation(s)
| | | | | | | | | | - Nam Tran
- Pathology and Laboratory Medicine, UC Davis Health, Sacramento, CA
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Lipps AA, Bazan JA, Lustberg ME, Sobhanie MM, Pollak B, Nandam K, Koletar SL, Lindsey S, Dick M, Malvestutto C. A Collaborative Intervention Between Emergency Medicine and Infectious Diseases to Increase Syphilis and HIV Screening in the Emergency Department. Sex Transm Dis 2022; 49:50-54. [PMID: 34108412 PMCID: PMC8663525 DOI: 10.1097/olq.0000000000001496] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2021] [Accepted: 06/07/2021] [Indexed: 11/20/2022]
Abstract
BACKGROUND Sexually transmitted infections (STIs) are a common reason for evaluation in the emergency department (ED). Given the overlapping risk factors for STIs, patients screened for gonorrhea and chlamydia should be tested for syphilis and HIV. Syphilis and HIV testing rates in the ED have been reported to be low. The study objective was to examine whether collaboration between emergency medicine (EM) and infectious disease (ID) providers improved syphilis and HIV testing in the ED. METHODS A multidisciplinary team of EM and ID providers was formed to identify and address barriers to syphilis and HIV testing in the ED. Syphilis, HIV, chlamydia, and gonorrhea testing and infection rates were calculated and compared during 2 time periods: preintervention (January 1, 2012-December 30, 2017) and postintervention (November 1, 2018-November 30, 2019). We also extracted clinical and laboratory data from patients with positive syphilis and HIV results during the study period. RESULTS The most commonly cited barrier to syphilis and HIV testing was concern about follow-up of positive results. Compared with the preintervention period, syphilis and HIV testing rates increased significantly in the postintervention period (incidence rate ratios, 30.70 [P < 0.0001] and 28.99 [P < 0.0001] for syphilis and HIV, respectively). The postintervention period was also associated with a significant increase in the identification of patients with positive syphilis and HIV results (incidence rate ratios, 7.02 [P < 0.0001] and 2.34 [P = 0.03], respectively). CONCLUSIONS Collaboration between EM and ID providers resulted in a significant increase in syphilis and HIV testing and diagnosis in the ED.
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Affiliation(s)
- Ashley A. Lipps
- From the Division of Infectious Diseases, The Ohio State University College of Medicine
| | - Jose A. Bazan
- From the Division of Infectious Diseases, The Ohio State University College of Medicine
- Sexual Health Clinic, Columbus Public Health
| | - Mark E. Lustberg
- From the Division of Infectious Diseases, The Ohio State University College of Medicine
| | | | | | - Kushal Nandam
- Department of Emergency Medicine, The Ohio State University College of Medicine, Columbus, OH
| | - Susan L. Koletar
- From the Division of Infectious Diseases, The Ohio State University College of Medicine
| | - Sommer Lindsey
- Department of Emergency Medicine, The Ohio State University College of Medicine, Columbus, OH
| | - Michael Dick
- Department of Emergency Medicine, The Ohio State University College of Medicine, Columbus, OH
| | - Carlos Malvestutto
- From the Division of Infectious Diseases, The Ohio State University College of Medicine
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Kruse MI, Voloshin D, Wan M, Clarizio A, Bigham BL, Upadhye S. Care of Sexual and Gender Minorities in the Emergency Department: A Scoping Review. Ann Emerg Med 2021; 79:196-212. [PMID: 34785088 DOI: 10.1016/j.annemergmed.2021.09.422] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2021] [Revised: 09/03/2021] [Accepted: 09/10/2021] [Indexed: 11/17/2022]
Abstract
STUDY OBJECTIVE This scoping review was conducted to collate and summarize the published research literature addressing sexual and gender minority care in the emergency department (ED). METHODS Using PRISMA-ScR criteria, an electronic search was conducted of CINAHL, Embase, Ovid Medline, and Web of Science for all studies that were published after 1995 involving sexual and gender minorities, throughout all life stages, presenting to an ED. We excluded non-US and Canadian studies and editorials. Titles and abstracts were screened, and full-text review was performed independently with 4 reviewers. Abstraction focused on study design, demographics, and outcomes, and the resulting data were analyzed using an ad hoc iterative thematic analysis. RESULTS We found 972 unique articles and excluded 743 after title and abstract screening. The remaining 229 articles underwent full-text review, and 160 articles were included. Themes identified were HIV in sexual and gender minorities (n=61), population health (n=46), provider training (n=29), ED avoidance or barriers (n=23), ED use (n=21), and sexual orientation/gender identity information collection (n=9). CONCLUSION The current literature encompassing ED sexual and gender minority care cluster into 6 themes. There are considerable gaps to be addressed in optimizing culturally competent and equitable care in the ED for this population. Future research to address these gaps should include substantial patient stakeholder engagement in all aspects of the research process to ensure patient-focused outcomes congruent with sexual and gender minority values and preferences.
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Affiliation(s)
- Michael I Kruse
- Department of Family Medicine, Queen's University, Kingston, Ontario, Canada.
| | - Daniel Voloshin
- Michael G. DeGroote School of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Melissa Wan
- Department of Family Medicine, Queen's University, Kingston, Ontario, Canada
| | - Alexandra Clarizio
- Michael G. DeGroote School of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Blair L Bigham
- Division of Anesthesiology, Perioperative and Pain Medicine, Stanford University, Stanford, CA
| | - Suneel Upadhye
- Division of Emergency Medicine, McMaster University, Hamilton, Ontario, Canada
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Bristow CC, Klausner JD, Tran A. Clinical Test Performance of a Rapid Point-of-Care Syphilis Treponemal Antibody Test: A Systematic Review and Meta-analysis. Clin Infect Dis 2021; 71:S52-S57. [PMID: 32578863 PMCID: PMC7312211 DOI: 10.1093/cid/ciaa350] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
We reviewed relevant syphilis diagnostic literature and conducted a meta-analysis to address the question, "What is the sensitivity and specificity of the Syphilis Health Check, a rapid qualitative test for the detection of human antibodies to Treponema pallidum." The Syphilis Health Check is the only rapid syphilis test currently cleared by the Food and Drug Administration (FDA). We conducted a systematic review and a meta-analysis using Bayesian bivariate random-effects and fixed-effect models to create pooled estimates of sensitivity and specificity of the Syphilis Health Check. We identified 5 test evaluations published in the literature and 10 studies submitted to the FDA and for a Clinical Laboratory Improvement Amendments waiver application. The pooled sensitivity (95% CI) from the laboratory evaluations (n = 5) was 98.5% (92.1-100%), while pooled specificity was 95.9% (81.5-100.0%). The pooled sensitivity for prospective studies (n = 10) was 87.7% ( 71.8-97.2%), while pooled specificity was 96.7% (91.9-99.2%). Using nontreponemal supplemental testing, the sensitivity improved to a pooled sensitivity of 97.0% (94.8-98.6%). The Syphilis Health Check may provide accurate detection of treponemal antibody.
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Affiliation(s)
- Claire C Bristow
- Division of Infectious Diseases and Global Public Health, University of California, San Diego, San Diego, California, USA
| | - Jeffrey D Klausner
- Department of Medicine, University of California, Los Angeles, Los Angeles, California, USA
| | - Anthony Tran
- District of Columbia Department of Forensic Sciences, Public Health Laboratory Division, Washington, DC, USA
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Chaudhary F, Faghihimehr A, Subedi Y, Hodanazari SM, Yousaf MN. Syphilitic Aortic Aneurysm: A Rare Entity in the Era of Antibiotics. Cureus 2021; 13:e13647. [PMID: 33824800 PMCID: PMC8012739 DOI: 10.7759/cureus.13647] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
A thoracic aortic aneurysm is a rare entity of tertiary syphilis in the era of antibiotics. The diagnosis of the aortic aneurysm due to tertiary syphilis may be challenging due to deceptive clinical presentation and rarity of the disease in the western world. We report the case of a 59-year-old man, who presents with worsening shortness of breath and was found to have a large ascending aortic aneurysm on computed tomography angiogram (CTA) of the chest. Further workup demonstrated a positive syphilis test. Untreated earlier stages of syphilis attribute to the development of the ascending aortic aneurysm. The patient was medically treated with IV penicillin and underwent surgical repair of the aortic aneurysm. Histopathology confirmed the diagnosis of syphilitic aortitis. Tertiary syphilis often presents several years after initial infection and usually after a latent phase, making it difficult to diagnose. Syphilitic aortic aneurysms may result in a high mortality rate in untreated patients. Therefore, a high index of suspicion is required for the early recognition of a syphilitic aortic aneurysm. Early treatment with antibiotic therapy and surgical repair of syphilitic aortic aneurysms can prevent life-threatening complications.
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Affiliation(s)
- Fizah Chaudhary
- Medicine, MedStar Union Memorial Hospital, Baltimore, USA.,Medicine, MedStar Franklin Square Medical Center, Baltimore, USA.,Medicine, MedStar Harbor Hospital, Baltimore, USA
| | | | - Yogesh Subedi
- Medicine, MedStar Union Memorial Hospital, Baltimore, USA.,Medicine, MedStar Franklin Square Medical Center, Baltimore, USA.,Medicine, MedStar Harbor Hospital, Baltimore, USA
| | | | - Muhammad N Yousaf
- Medicine, MedStar Union Memorial Hospital, Baltimore, USA.,Medicine, MedStar Franklin Square Medical Center, Baltimore, USA.,Medicine, MedStar Good Samaritan Hospital, Baltimore, USA.,Medicine, MedStar Harbor Hospital, Baltimore, USA
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Yax JA, Niforatos JD, Summers DL, Bigach MH, Schmotzer C, Gripshover BM, Avery A. A Model for Syphilis Screening in the Emergency Department. Public Health Rep 2020; 136:136-142. [PMID: 33166486 DOI: 10.1177/0033354920967302] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
The incidence of syphilis infections is on the rise, particularly among African American men and men who have sex with men, and it is reaching epidemic levels in these communities throughout the United States. Although syphilis is relatively inexpensive to treat and cure and is a predictor for HIV incidence among men and transgender women who have sex with men, rates of co-screening for syphilis are low in the emergency department setting, with a dearth of literature on this topic since the 1990s and early 2000s. In this case study, we describe an operational model for routine syphilis screening implemented in June 2017 at the University Hospitals Cleveland Medical Center in Cleveland, Ohio. We describe the advantages of screening using a reverse testing algorithm rather than the traditional method and the necessity of partnering with the Cleveland Department of Public Health for both diagnostic and follow-up logistics.
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Affiliation(s)
- Justin A Yax
- 24575 Division of Population Health, Department of Emergency Medicine, University Hospitals Cleveland Medical Center, Cleveland, OH, USA.,Case Western University School of Medicine, Cleveland, OH, USA
| | - Joshua D Niforatos
- 24575 Division of Population Health, Department of Emergency Medicine, University Hospitals Cleveland Medical Center, Cleveland, OH, USA.,161821 Department of Emergency Medicine, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - Daniel L Summers
- 24575 Division of Population Health, Department of Emergency Medicine, University Hospitals Cleveland Medical Center, Cleveland, OH, USA
| | - Margaret H Bigach
- 24575 Division of Population Health, Department of Emergency Medicine, University Hospitals Cleveland Medical Center, Cleveland, OH, USA
| | - Christine Schmotzer
- Case Western University School of Medicine, Cleveland, OH, USA.,24575 Department of Pathology, University Hospitals Cleveland Medical Center, Cleveland, OH, USA
| | - Barbara M Gripshover
- Case Western University School of Medicine, Cleveland, OH, USA.,365856 John T. Carey Special Immunology Unit, Department of Medicine, Division of Infectious Diseases and HIV Medicine, University Hospitals Cleveland Medical Center, Cleveland, OH, USA
| | - Ann Avery
- Case Western University School of Medicine, Cleveland, OH, USA.,2559 Division of Infectious Diseases, MetroHealth Medical Center, Cleveland Medical Center, Cleveland, OH, USA
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Stanford KA, Hazra A, Schneider J. Routine Opt-out Syphilis Screening in the Emergency Department: A Public Health Imperative. Acad Emerg Med 2020; 27:437-438. [PMID: 31802561 DOI: 10.1111/acem.13897] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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