Ford James S, Shevchyk Ivan, Yoon Joseph, Chechi Tasleem, Voong Stephanie, Tran Nam, May Larissa
From the Departments of Emergency Medicine.
Pathology and Laboratory Medicine, UC Davis Health, Sacramento, CA.
Sex Transm Dis. 2022 Feb 1;49(2):105-110. doi: 10.1097/OLQ.0000000000001543.
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.
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.
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]).
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.
在美国，梅毒的患病率正在上升。急诊科是筛查和治疗服务不足人群的重要场所。为了根据当地人群调整检测方案，我们旨在确定急诊科患者梅毒检测呈阳性的风险因素。
我们对2018年11月至2020年8月期间接受梅毒筛查的急诊科患者进行了回顾性分析。使用多重流式免疫测定法对患者进行梅毒螺旋体抗体筛查，阳性结果通过快速血浆反应素或梅毒螺旋体颗粒凝集试验进行确认。使用多因素逻辑回归确定新梅毒诊断的风险因素。
我们对1974例患者进行了梅毒筛查（平均年龄为37±16岁；56%为女性）。我们确定了201例未经治疗的新感染患者。梅毒新诊断的独立风险因素包括居住状况（无家可归，23%[256例中的60例]；有家可归，9%[1559例中的133例]；调整后的优势比[aOR]，1.9[95%置信区间{CI}，1.2 - 3.0]）、艾滋病毒病史（阳性，44%[63例中的28例]；阴性，9%[1893例中的173例]；aOR，5.8[95%CI，3.0 - 11.2]）、吸烟史（阳性，15%[797例中的117例]；阴性，4%[665例中的29例]；aOR，2.4[95%CI，1.5 - 3.9]）和非法药物使用史（阳性，14%[812例中的112例]；阴性，8%[678例中的52例]；aOR，2.2[95%CI，1.0 - 2.5]）。
无家可归的居住状况、艾滋病毒病史、吸烟史和非法药物使用史与急诊科梅毒的新诊断独立相关。将针对性梅毒筛查算法扩大到性传播疾病相关主诉之外，有助于识别新的梅毒病例以便治疗。
