QI project increases syphilis screenings, JAMA
A recent viewpoint article stressing the importance of point-of-care syphilis testing to combat the troubling rates of congenital syphilis among pregnant patients in Texas has been published in JAMA.
Research was led by Irene Stafford, MD, associate professor in the Department of Obstetrics, Gynecology, and Reproductive Sciences, as well as Kristin M. Wall, MS, PhD; Kimberly Workowski, MD; and Marisa Young, MD, PhD, from Emory University.
Congenital syphilis is a severe infection that can lead to intrauterine fetal demise and neonatal death in up to 40% of untreated pregnancies. According to data released by the CDC in 2023, Texas accounts for nearly a quarter of all congenital syphilis cases in the US with Houston presenting the highest number of cases in the state.
Stafford said her group recognized a missed opportunity for congenital syphilis prevention after discovering that up to 30% of pregnant patients with a newborn with congenital syphilis visited the emergency department and were not tested for the disease. This led to the team partnering with emergency department leadership and hospital administration to help tackle the growing health problem and offer rapid and opt-out testing for pregnant women at Memorial Hermann Hospital – Texas Medical Center.
A quality improvement project was initiated to determine if the rapid point-of-care syphilis testing, alongside traditional lab-based testing, would help increase participation in the testing and treatment for pregnant individuals who had not established prenatal care and faced structural health barriers.
“It was exciting to discover that in just three months, the opt-out and rapid syphilis testing program for pregnant people visiting the ED increased syphilis screening from 2% to 56.4%,” Stafford said. “Having this test to turn around time in less than 15 minutes, we were able to treat all pregnant patients with positive results and provide linkage to care services at that emergency department encounter.”
Stafford mentioned that the success of the program led to an expansion to the Harris Health affiliates at Lyndon B. Johnson hospital and also turned the project into a larger study, where they can focus not only on testing and treating in the emergency room, but also continue to support follow up care and evaluate the effect of the program on decreasing congenital syphilis rates.
“Syphilis and other STI disproportionately affect underserved populations that struggle with access to traditional prenatal care,” Stafford said. “Health care focus needs to expand to include providing services in nontraditional settings, including emergency centers. This study demonstrates that equitable care can happen with coordination and support from all invested stakeholders.”