Stafford Irene, Bakunas Carrie, Haydamous Joe, Mosqueda Ana, Klausner Jeffrey D, Mena Leandro, Blackwell Sean C
From the University of Texas at Houston McGovern Medical School, Houston, TX.
University of Southern California, Los Angeles, CA.
Sex Transm Dis. 2025 Jun 1;52(6):352-355. doi: 10.1097/OLQ.0000000000002131. Epub 2024 Dec 24.
Adult and congenital syphilis rates are rising in the United States. The aim of this pre- and post-implementation study was to determine whether implementation of an opt-out laboratory-based and rapid syphilis point-of-care testing program in the emergency department (ED) improves the detection and treatment of syphilis during pregnancy in a high-prevalence region.
This pre- and post-implementation study was conducted at the University of Texas Health Science Center, Houston, TX. During the pre-implementation phase (November 1, 2023-February 29, 2024), pregnant patients presenting to the ED underwent laboratory-based syphilis testing using the reverse algorithm only when clinically indicated. In the post-implementation phase (March 1, 2024-June 25, 2024), pregnant patients without prenatal care or with no documented syphilis result underwent opt-out syphilis testing using the Syphilis Health Check point-of-care test and the laboratory-based reverse syphilis testing algorithm. Patients with positive syphilis test results were treated by providers. All results were confirmed with the laboratory-based test, and patient follow-up was scheduled.
During the pre-implementation period, 302 pregnant patients presented to the ED, and only 6 (2%) underwent syphilis laboratory-based testing, none of which yielded positive results. In the post-implementation period, 322 pregnant patients presented to the ED and 202 (62.7%) were approached. Of these, 114 (56.4%) were tested using either the Syphilis Health Check or laboratory-based reverse algorithm ( P < 0.001). Four patients tested positive for syphilis, indicating a prevalence of 3.5%.
An opt-out and rapid syphilis testing program for pregnant individuals visiting the ED increased syphilis screening from 2% to 56.4%, and detected syphilis that might have otherwise been missed.
美国成人及先天性梅毒发病率呈上升趋势。本实施前和实施后研究的目的是确定在急诊科实施基于实验室的梅毒检测及快速即时检测（POCT）的主动筛查项目，是否能提高梅毒在高流行地区孕期的检测及治疗率。
本实施前和实施后研究在德克萨斯大学健康科学中心（位于德克萨斯州休斯顿）开展。在实施前阶段（2023年11月1日至2024年2月29日），到急诊科就诊的孕妇仅在临床有指征时才采用反向算法进行基于实验室的梅毒检测。在实施后阶段（2024年3月1日至2024年6月25日），未接受过产前检查或无梅毒检测记录的孕妇接受主动筛查梅毒检测，采用梅毒健康检查即时检测及基于实验室的梅毒反向检测算法。梅毒检测结果呈阳性的患者由医护人员进行治疗。所有结果均通过基于实验室的检测进行确认，并安排患者随访。
在实施前阶段，302名孕妇到急诊科就诊，仅6名（2%）接受了基于实验室的梅毒检测，均未得到阳性结果。在实施后阶段，322名孕妇到急诊科就诊，其中202名（62.7%）接受了检测。其中，114名（56.4%）采用梅毒健康检查或基于实验室的反向算法进行了检测（P<0.001）。4名患者梅毒检测呈阳性，患病率为3.5%。
针对到急诊科就诊的孕妇实施的主动筛查和快速梅毒检测项目，将梅毒筛查率从2%提高到了56.4%，并检测出了可能漏诊的梅毒病例。
