EMERGENCY DEPARTMENT-BASED SURVEILLANCE FOR SYPHILIS DURING AN OUTBREAK IN PHILADELPHIA

Study objective: To identify missed opportunities for syphilis treatme nt during an outbreak. Design: Prospective prevalence survey. Setting: Urban hospital emergency department. Participants: Nine hundred sixty -one persons aged 15 to 44 years seeking medical attention in the ED w ho were not suspected of having any sexually transmitted disease (STD) at the time of their visit. Intervention: Serologic testing for syphi lis and public health follow-up as needed. Measurements and main resul ts: Twenty-one non-STD patients (2%) had untreated early syphilis, and 22 (2%) had positive serology but were lost to follow-up. Among 271 S TD patients seen in the ED during the same period, 15 cases (6%) were detected. We estimate that 80 or more additional untreated early syphi lis cases would have been identified had all 15- to 44-year-old patien ts entering the ED been tested. The cost of screening was $251 per cas e detected. Conclusion: Patients not suspected of having any STD accou nt for most early syphilis cases among all ED patients. Screening and on-site treatment for syphilis should be offered to all young adults s eeking medical attention in the ED during syphilis outbreaks.