Document 0804
 DOCN  M9620804
 TI    Screening and empiric treatment for syphilis in an inner-city emergency
       department.
 DT    9602
 AU    Ernst AA; Farley TA; Martin DH; Department of Medicine, Louisiana State
       University, Charity; Hospital, New Orleans 70140, USA.
 SO    Acad Emerg Med. 1995 Sep;2(9):765-72. Unique Identifier : AIDSLINE
       MED/96026567
 AB    OBJECTIVE: To examine targeted screening and empiric treatment for
       syphilis in an urban ED. METHODS: Screening of emergency patients during
       previously arranged shifts from July 1991 through January 1992 in a
       university-affiliated, inner-city ED. Emergency patients who perceived
       that they had high-risk factors for syphilis (i.e., cocaine or heroin
       use or sexual contact with a user of these substances) were compared
       with emergency patients denying high risk. All presumed high-risk
       patients and alternate patients in the group who denied high risk
       (control group) were screened in the ED with the rapid plasma reagin
       (RPR) test. Empiric antibiotic treatment was initiated if the patient
       was RPR-positive and gave no previous history of syphilis. In addition,
       serum was submitted to the state laboratory for VDRL and
       microhemagglutination-Treponema pallidum (MHA-TP) testing. Blinded
       serologic testing for HIV antibody was performed later on frozen serum.
       RESULTS: Of 806 patients presenting to the ED, 276 (34%) admitted to
       high-risk behavior. Of 373 patients tested by RPR in the ED (216
       high-risk and 157 control patients), no significant difference was found
       between the high-risk and the control patients in untreated syphilis [8
       (4%) vs 4 (3%)] or positive MHA-TP [47 (22%) vs 25 (16%)]. In the
       high-risk group, the women were more likely than the men to be
       MHA-TP-positive (OR = 2.58, 95% CI 1.12-7.98, p = 0.04). Among the
       women, the MHA-TP was more often positive for the high-risk than for the
       control patients (34% vs 15%, OR = 2.27, 95% CI 1.12-4.67, p = 0.023).
       For the high-risk group, seven (3%) new cases of syphilis were managed
       empirically, vs three (2%) new cases for the control group. HIV
       antibodies were detected in 16 of 212 (8%) high-risk patients and five
       of 155 (3%) control subjects (p = 0.13). CONCLUSION: This inner-city ED
       population has a high frequency of positive syphilis and HIV serologies,
       regardless of acknowledged drug use risk factors. Therefore, in areas
       reporting high syphilis infection rates, consideration should be given
       to offering screening for syphilis to all emergency patients, along with
       establishment of adequate counseling and follow-up.
 DE    Adolescence  Adult  Antibiotics, Tetracycline/THERAPEUTIC USE
       Doxycycline/THERAPEUTIC USE  Emergency Service, Hospital  Female  Human
       Louisiana/EPIDEMIOLOGY  Male  Mass Screening  Penicillin G,
       Benzathine/THERAPEUTIC USE  Penicillins/THERAPEUTIC USE  Prospective
       Studies  Support, Non-U.S. Gov't  Syphilis/DRUG
       THERAPY/*EPIDEMIOLOGY/PREVENTION & CONTROL  *Urban Population  JOURNAL
       ARTICLE

       SOURCE: National Library of Medicine.  NOTICE: This material may be
       protected by Copyright Law (Title 17, U.S.Code).