Implementation of an Opt-out and Rapid Point-Of-Care Syphilis Testing Program for Pregnant Patients Presenting to the Emergency Department

Background: Adult and congenital syphilis rates are rising in the US. 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.

Methods: This pre-and post-implementation study was conducted at the University of Texas Health Science Center, Houston, TX. During the pre-implementation phase (11/01/2023 - 02/29/2024), pregnant patients presenting to the ED underwent lab-based syphilis testing using the reverse algorithm only when clinically indicated. In the post-implementation phase (03/01/2024 - 06/25/2024), pregnant patients without prenatal care or with no documented syphilis result underwent opt-out syphilis testing using the Syphilis Health Check (SHC) point-of-care test and the lab-based reverse syphilis testing algorithm. Patients with positive syphilis test results were treated by providers. All results were confirmed with the lab-based test and patient follow up was scheduled.

Results: During the pre-implementation period, 302 pregnant patients presented to the ED, and only 6 (2%) underwent syphilis lab-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 SHC or lab-based reverse algorithm (p < 0.001). Four patients tested positive for syphilis, indicating a prevalence of 3.5%.

Conclusions: 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.