Universal Syphilis Screening in the ED Outperforms Targeted Approaches: Daily Dose

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Patient Care brings primary care clinicians a lot of medical news every day—it’s easy to miss an important study. The Daily Dose provides a concise summary of one of the website's leading stories you may not have seen.

On March 20, 2025, we reported on findings from a study presented at the 2025 Conference on Retroviruses and Opportunistic Infections (CROI) that assessed the impact of a universal opt-out emergency department (ED) syphilis screening program.

The study

Researchers from the University of Chicago previously implemented a universal opt-out ED syphilis screening program in 2019 for all ED patients aged under 65 years at a large, urban tertiary care hospital in Chicago. Results presented at CROI 2024 showed that in the 2 years preceding the intervention, 6.2% of ED encounters included syphilis testing. This increased nearly eightfold to 52.4% post-intervention. Additionally, more syphilis cases were identified after the intervention (16 vs 3).

To assess if a more targeted screening program would be successful, the research team retrospectively reviewed the screened population within the universal program and determined the number of patients who would have been missed if only targeted populations were tested. Groups targeted in the study included people being tested for gonorrhea or chlamydia, women of reproductive age, anyone receiving a blood draw and anyone receiving a complete blood count.

The findings

Over a 2-year period, 37 289 ED patients under the age of 65 were screened for syphilis, identifying 624 active cases (1.7%). To assess the effectiveness of targeted screening, the study examined hypothetical models that limited testing to specific groups:

• Screening only patients tested for gonorrhea or chlamydia would have identified just 147 cases (23.6% sensitivity).

• Screening only women of reproductive age would have detected 142 cases (22.8% sensitivity).

• Screening only those receiving any blood draw would have captured 516 cases (82.7% sensitivity).

• Screening only those undergoing a complete blood count (CBC) would have identified 472 cases (75.6% sensitivity).

Authors' comments

"While implementation of universal ED screening may require additional resources and infrastructure, it may be the most effective strategy to address the syphilis epidemic in high prevalence communities facing major health care disparities."

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