TOPLINE: 

Despite a 127% increase in screenings of sexually transmitted infections (STIs) in the emergency department (ED) from 2020 to 2024, only 9.9% of patients were screened for syphilis, according to a study. Missed screening was more common among female patients, insured patients, and patients with visits involving fewer co-tests.

METHODOLOGY:

• Researchers conducted a retrospective cohort study and analyzed 31,096 ED encounters among patients aged 13 years or older (mean age, 30.6 years; 72.1% female individuals; 48.5% non-Hispanic White individuals) who were tested for STIs (gonorrhea, chlamydia, or trichomoniasis) from 2020 to 2024.
• The outcome was a missed syphilis screening when any other STI test was performed. ED encounters without a syphilis test were defined as missed opportunities.
• Researchers examined temporal trends in screening volume and positivity, associations with subgroups (age, sex, insurance, time of ED arrival, and ED opt‑out status), and the effect of the number of co‑tests performed per encounter.

TAKEAWAY:

• Screening rates for syphilis increased by 127.1% over 5 years. Syphilis screening occurred in 9.9% of ED encounters, with positivity rates decreasing from 10.4% to 3.5%.
• Patients aged 22-24 years had higher odds of missed opportunity than those aged 30-34 years (adjusted odds ratio [aOR], 1.11). Increased odds were observed among female (aOR, 1.82) and insured (aOR, 1.17) patients.
• Patients who received a single STI test were 3.5 times more likely to miss syphilis screening than those who received three tests (aOR, 3.47). Patients with no prior history of HIV infection (aOR, 1.77) or syphilis (aOR, 2.82) also had higher odds of missed screening.
• Patients who attended an ED with an opt-out program and those with a history of STI had lower odds of missed screening (aORs, 0.87 and 0.80, respectively).

IN PRACTICE:

"Our study highlights critical gaps in syphilis screening within the EDs of a large southern healthcare system and identifies specific populations at increased risk for missed screening opportunities. While future research examining the most effective screening strategies is needed, potential options may include adding syphilis to routine STI panels, using EMR [electronic medical record]-based clinical decision support, and providing targeted provider education," the authors wrote.

SOURCE:

The study was led by Madelyn Krueger, Prisma Health, Greenville, South Carolina. It was published online on January 23, 2026, in The American Journal of Emergency Medicine.

LIMITATIONS: 

The study had a retrospective design within a single health system, which may have limited generalizability. This design also limited the ability to account for all potential confounding factors affecting missed syphilis‑screening opportunities. Additionally, higher screening rates in opt‑out program EDs may have been affected by additional staff education rather than by the program structure alone.

DISCLOSURES:

The study did not receive any specific funding, and the authors reported having no conflicts of interest.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.