Ernst A A, Farley T A, Martin D H
Department of Medicine, Louisiana State University, Charity Hospital, New Orleans 70140, USA.
Acad Emerg Med. 1995 Sep;2(9):765-72. doi: 10.1111/j.1553-2712.1995.tb03269.x.
To examine targeted screening and empiric treatment for syphilis in an urban ED.
Screening of emergency patients during previously arranged shifts from July 1991 through January 1992 in a university-affiliated, inner-city ED. Emergency patients who perceived that they had high-risk factors for syphilis (i.e., cocaine or heroin use or sexual contact with a user of these substances) were compared with emergency patients denying high risk. All presumed high-risk patients and alternate patients in the group who denied high risk (control group) were screened in the ED with the rapid plasma reagin (RPR) test. Empiric antibiotic treatment was initiated if the patient was RPR-positive and gave no previous history of syphilis. In addition, serum was submitted to the state laboratory for VDRL and microhemagglutination-Treponema pallidum (MHA-TP) testing. Blinded serologic testing for HIV antibody was performed later on frozen serum.
Of 806 patients presenting to the ED, 276 (34%) admitted to high-risk behavior. Of 373 patients tested by RPR in the ED (216 high-risk and 157 control patients), no significant difference was found between the high-risk and the control patients in untreated syphilis [8 (4%) vs 4 (3%)] or positive MHA-TP [47 (22%) vs 25 (16%)]. In the high-risk group, the women were more likely than the men to be MHA-TP-positive (OR = 2.58, 95% CI 1.12-7.98, p = 0.04). Among the women, the MHA-TP was more often positive for the high-risk than for the control patients (34% vs 15%, OR = 2.27, 95% CI 1.12-4.67, p = 0.023). For the high-risk group, seven (3%) new cases of syphilis were managed empirically, vs three (2%) new cases for the control group. HIV antibodies were detected in 16 of 212 (8%) high-risk patients and five of 155 (3%) control subjects (p = 0.13).
This inner-city ED population has a high frequency of positive syphilis and HIV serologies, regardless of acknowledged drug use risk factors. Therefore, in areas reporting high syphilis infection rates, consideration should be given to offering screening for syphilis to all emergency patients, along with establishment of adequate counseling and follow-up.
探讨城市急诊科梅毒的针对性筛查和经验性治疗。
1991年7月至1992年1月在一所大学附属的市中心急诊科，对预先安排班次期间的急诊患者进行筛查。将自认为有梅毒高危因素（即使用可卡因或海洛因或与这些物质使用者有性接触）的急诊患者与否认有高危因素的急诊患者进行比较。所有假定的高危患者以及否认高危的组中的替代患者（对照组）在急诊科用快速血浆反应素（RPR）试验进行筛查。如果患者RPR呈阳性且既往无梅毒病史，则开始经验性抗生素治疗。此外，血清被送往州实验室进行性病研究实验室（VDRL）和梅毒螺旋体微量血凝试验（MHA-TP）检测。随后对冷冻血清进行HIV抗体的盲法血清学检测。
在806名到急诊科就诊的患者中，276名（34%）承认有高危行为。在急诊科接受RPR检测的373名患者中（216名高危患者和157名对照患者），高危患者和对照患者在未经治疗的梅毒[8例（4%）对4例（3%）]或MHA-TP阳性[47例（22%）对25例（16%）]方面没有显著差异。在高危组中，女性比男性更易出现MHA-TP阳性（比值比[OR]=2.58，95%可信区间[CI]1.12 - 7.98，p = 0.04）。在女性中，高危患者的MHA-TP阳性率比对照患者更高（34%对15%，OR = 2.27，95%CI 1.12 - 4.67，p = 0.023）。对于高危组，7例（3%）梅毒新病例接受了经验性治疗，而对照组为3例（2%）新病例。在212名（8%）高危患者中有16名检测到HIV抗体，在155名（3%）对照受试者中有5名检测到（p = 0.13）。
无论是否存在公认的药物使用风险因素，这个市中心急诊科人群梅毒和HIV血清学阳性的频率都很高。因此，在梅毒感染率高的地区，应考虑对所有急诊患者进行梅毒筛查，并建立适当的咨询和随访。
