(521) Opt-out and rapid syphilis testing in pregnant patients presenting to the ED: A pre-post study

Thursday, January 30, 2025

4:00 PM – 6:00 PM

Submitting Author and Presenting Author(s)

Joe Haydamous, MD (he/him/his)

Research Assistant 3
Division of Maternal-Fetal Medicine, Department of Obstetrics, Gynecology and Reproductive Sciences, McGovern Medical School at UTHealth Houston
Houston, Texas, United States

Coauthor(s)

AD

Ana Davie, MD

Division of Maternal-Fetal Medicine, Department of Obstetrics, Gynecology and Reproductive Sciences, McGovern Medical School at UTHealth Houston
Houston, Texas, United States
JN

Jose C. Noriega Valdez, MD

Division of Maternal-Fetal Medicine, Department of Obstetrics, Gynecology and Reproductive Sciences, McGovern Medical School at UTHealth Houston
Houston, Texas, United States
CI

Cassandra Igbe, BS, MPH

Research Associate
Division of Maternal-Fetal Medicine, Department of Obstetrics, Gynecology and Reproductive Sciences, McGovern Medical School at UTHealth Houston
Houston, Texas, United States
AB

Aidan Blackwell

Division of Maternal-Fetal Medicine, Department of Obstetrics, Gynecology and Reproductive Sciences, McGovern Medical School at UTHealth Houston
Houston, Texas, United States
CB

Carrie Bakunas, MD

Department of Emergency Medicine, McGovern Medical School at The University of Texas Health Science Center at Houston (UTHealth), Houston, Texas
Houston, Texas, United States
JK

Jeffrey K. Klausner, MD

University of Southern California
Los Angeles, California, United States
LM

Leandro Mena, MD, MPH

Owner and Senior Consultant
All-In Health Solutions LLC
Atlanta, Georgia, United States
Irene A. Stafford, MD, MS

Associate Professor
McGovern Medical School at UTHealth Houston
Houston, Texas, United States

Objective: According to regional pilot data, 35% of pregnant patients with newborns diagnosed with congenital syphilis (CS) visited the emergency department (ED) during pregnancy but were not tested for syphilis. This represents a critical missed opportunity to identify and treat syphilis in pregnant patients and reduce the incidence of CS. This pre- and post-implementation study aims to determine if implementing an opt-out laboratory-based and rapid syphilis testing program improves the detection and treatment of syphilis during pregnancy in the ED.

Study Design: This pre-post implementation study was conducted at the University of Texas Health Science Center, Houston, TX after institutional approval. During the pre-implementation phase (11/01/2023 - 02/29/2024), eligible pregnant patients presenting to the ED underwent standard lab-based syphilis testing only when clinically indicated. In the post-implementation phase (03/01/2024 - 06/25/2024), pregnant patients without a documented syphilis result or prenatal care received lab-based opt-out syphilis testing with or without the Syphilis Health Check (SHC) point-of-care test, with coordinators facilitating linkage to prenatal care for all patients.

Results: During the pre-implementation period, 302 pregnant patients presented to the ED for care, with only 6 (2%) undergoing syphilis testing, yielding no positive results. In the post-implementation period, 322 pregnant patients presented to the ED. Of these, 79 (24.5%) were tested for syphilis, representing a 12.5-fold increase in screening (p < 0.001). Three patients tested positive for syphilis, indicating a 3.8% prevalence rate. Moreover, 70% of those who tested positive were scheduled for prenatal care by research coordinators dedicated to the project.

Conclusion: The implementation of an opt-out and rapid syphilis testing program for underserved pregnant patients in the ED led to a significant increase in syphilis testing and referral for treatment. The public health impact of this program for adults and neonates is likely to demonstrate further substantial benefits, particularly in high-prevalence regions.