EMERGENCY DEPARTMENT SCREENING FOR SYPHILIS IN PREGNANT-WOMEN WITHOUTPRENATAL-CARE

Study objective: To determine if there is a high seroprevalence of syp hilis in pregnant women without prenatal care presenting to an urban e mergency department. Design: Prospective, nonblinded sampling of pregn ant women without prenatal care with a comparison group of pregnant wo men with prenatal care from the obstetrics clinic. Patients in the ED setting were asked about such associated risk factors as previous syph ilis and drug use. Setting: Urban ED. Type of participants: Pregnant w omen without prenatal care. Intervention: Patients were screened for s yphilis using the automated reagin test. Reactive automated reagin tes ts were confirmed by the fluorescent treponemal antibody absorption. I n addition, 44 patients with nonreactive automated reagin tests had co nfirmatory tests done. New cases were verified by the state health dep artment. Measurements and main results: Seventy-two patients were incl uded in the study. The average age was 25 years. Eight patients (11.1% ) were diagnosed with previously undetected syphilis. Four patients (5 .6%) had previously treated syphilis. The laboratory cost of screening was $248 per new case of syphilis detected. The study group was compa red with 118 patients matched for age and race who presented to the ob stetrics clinic for routine prenatal care. Two new cases of syphilis w ere discovered in the clinic population (1.7%). Conclusion: A high rat e of syphilis infection was detected in this inner-city ED population presenting without prenatal care. This was higher than that found in t he patients presenting for obstetrics care in the clinic. Patients can be screened effectively in the ED.