SYPHILIS SCREENING IN OUT-OF-HOSPITAL CARE

To estimate the rates of syphilis infection in inner-city patients man aged by prehospital providers, a convenience sampling of prehospital p atients who had intravenous lines initiated was screened for syphilis over a nine-month study period from February 1992 through October 1992 . In a university-affiliate inner-city emergency department served by a city ambulance company, patients 18 years of age or older transporte d via ambulance who had had intravenous lines initiated at the scene o r en route had a Venereal Disease Research Laboratory (VDRL) and micro hemagglutination-Treponema pallidum (MHA-TP) drawn and performed by th e state laboratory as a routine serological test. If the results were reactive with no previous history of syphilis recorded in the state re gistry, the state health department and/or one of the authors of this study contacted the patient for follow-up treatment. Age, race, sex, a nd diagnostic category (medical, surgical/obstetric, or neuropsychiatr ic) were recorded. Results were checked with the state syphilis regist ry. Latent syphilis was defined as a reactive VDRL and MHA-TP with no prior history of infection or record of infection in the state syphili s registry. Chi-squared test was used in statistical analysis for comp arisons among ages, races, and sexes, with P > .05 considered signific ant. Three hundred two subjects 18 years of age and older consenting t o a screening VDRL and MHA-TP had serum drawn. Two hundred seventy-nin e patients were enrolled in the study after 23 patients were excluded because of improper data collection or insufficient serum collection. There were 174 men (63%) and 105 women (37%), with 73 white (26%) and 199 African-Americans (71%). There was a significantly higher percenta ge of MHA-TP-positive patients among women than men (21% v 10%, differ ence of 11%, 95% confidence intervals [CI] 2.2% to 20.1%) and among Af rican-Americans than whites (18.5% v 2.7%, difference of 15.9%, 95% CI 9.3% to 22.4%). Seven patients (2.5%) had previously untreated latent syphilis. No difference was detected among the three diagnostic categ ories. It was concluded that there is a high rate of untreated syphili s in patients transported by inner-city emergency medical services (EM S). Although rates were significantly higher in blacks and in women, t he overall rate was high enough to warrant screening of all patients. Because syphilis can he transmitted by blood exposure, screening of pr ehospital providers may be warranted. (C) 1995 by W.B. Saunders Compan y