Syphilis screening in out-of-hospital care

To estimate the rates of syphilis infection in inner-city patients managed by prehospital providers, a convenience sampling of prehospital patients who had intravenous lines initiated was screened for syphilis over a nine-month study period from February 1992 through October 1992. In a university-affiliated inner-city emergency department served by a city ambulance company, patients 18 years of age or older transported via ambulance who had had intravenous lines initiated at the scene or en route had a Venereal Disease Research Laboratory (VDRL) and microhe-magglutination-Treponema pallidum (MHA-TP) drawn and performed by the state laboratory as a routine serological test. If the results were reactive with no previous history of syphilis recorded in the state registry, the state health department and/or one of the authors of this study contacted the patient for follow-up treatment. Age, race, sex, and diagnostic category (medical, surgical/obstetric, or neuropsychiatric) were recorded. Results were checked with the state syphilis registry. Latent syphilis was defined as a reactive VDRL and MHA-TP with no prior history of infection or record of infection in the state syphilis registry. Chisquared test was used in statistical analysis for comparisons among ages, races, and sexes, with P> .05 considered significant. Three hundred two subjects 18 years of age and older consenting to a screening VDRL and MHA-TP had serum drawn. Two hundred seventy-nine patients were enrolled in the study after 23 patients were excluded because of improper data collection or insufficient serum collection. There were 174 men (63%) and 105 women (37%), with 73 white (26%) and 199 African-Americans (71%). There was a significantly higher percentage of MHA-TP-positive patients among women than men (21% v 10%, difference of 11%, 95% confidence intervals [Cl] 2.2% to 20.1%) and among African-Americans than whites (18.5% v 2.7%, difference of 15.9%, 95% Cl 9.3% to 22.4%). Seven patients (2.5%) had previously untreated latent syphilis. No difference was detected among the three diagnostic categories. It was concluded that there is a high rate of untreated syphilis in patients transported by inner-city emergency medical services (EMS). Although rates were significantly higher in blacks and in women, the overall rate was high enough to warrant screening of all patients. Because syphilis can be transmitted by blood exposure, screening of prehospital providers may be warranted.