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. 2025 Jun 1;52(6):352-355.
doi: 10.1097/OLQ.0000000000002131. Epub 2024 Dec 24.

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

Irene Stafford  1 , Carrie Bakunas  1 , Joe Haydamous  1 , Ana Mosqueda  1 , Jeffrey D Klausner  2 , Leandro Mena  3 , Sean C Blackwell  1
Affiliations

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

Irene Stafford et al. Sex Transm Dis. .

Abstract

Background: 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.

Methods: 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.

Results: 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%.

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.

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Conflict of interest statement

Conflict of Interest and Sources of Funding: Dr. Irene Stafford claims no conflicts of interest. She received funding from the National Institutes of Health for congenital and adult syphilis research. Diagnostics Direct donated Syphilis Health Check test kits.

Figures

Figure 1
Figure 1
Flow diagram of the study population.
Figure 2
Figure 2
Syphilis testing in pregnant patients presenting to ED: pre- and post-implementation.
See this image and copyright information in PMC

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