Decade Assessment of Syphilis and HIV Screening in Pediatric Emergency Departments
Abstract
The Centers for Disease Control and Prevention (CDC) recommends HIV screening for patients ≥13 years. There is an association between HIV and other sexually transmitted infections (STIs), specifically syphilis. HIV and syphilis co-infection are linked to increased HIV transmission, viral shedding, and viral loads. Children’s Healthcare of Atlanta (Children’s) implemented a best practice alert (BPA) in their medical record to capture HIV and STI testing in 2016. The emergency department (ED) is often used as a main source of care which fostered our aim to identify HIV and syphilis testing patterns over the last decade.
Children’s population discovery tool-Grandpop was used to compare Children’s ED HIV and syphilis testing volumes of patients 13–24-year-olds, from January 1, 2013, to December 31, 2023. Data was categorized by sex, positive results, mean age, and positivity rate. Descriptive statistics were utilized.
During the decade, 9283 patients were tested for syphilis, 7056(76%) females and 2227(24%) males, mean age16.0± 0.3. There were 203 positives, 138(68%) females and 65(32%) males, positivity rate of 2.2%. A higher prevalence was found in males (2.9%) vs females (1.9%). For HIV, 11,055 patients were tested, 8037(73%) females and 3018(27%) males, mean age,16.0± 0.2. There were 61 positives, 8(13%) females and 53(87%) males, positivity rate of 0.6%. Testing from 2013 to 2023 increased >7-fold for HIV and syphilis with a strong correlation (r= .98, P<0.001); screening increase was seen after the BPA launch. For positive results, HIV more than doubled while syphilis increased 8-fold when comparing 2013 to 2023.
This reveals a high prevalence of syphilis. Screening in the ED plays a pivotal role in identifying this public health crisis. Earlier detection, linkage to care and preventative resources are components that can target syphilis and HIV rates. The CDC should consider recommending opt-out syphilis testing given the growing disease burden.
Keywords
Emergency Medicine; Pediatric; Adolescents; HIV; Syphilis; Public health;
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Decade Assessment of Syphilis and HIV Screening in Pediatric Emergency Departments
The Centers for Disease Control and Prevention (CDC) recommends HIV screening for patients ≥13 years. There is an association between HIV and other sexually transmitted infections (STIs), specifically syphilis. HIV and syphilis co-infection are linked to increased HIV transmission, viral shedding, and viral loads. Children’s Healthcare of Atlanta (Children’s) implemented a best practice alert (BPA) in their medical record to capture HIV and STI testing in 2016. The emergency department (ED) is often used as a main source of care which fostered our aim to identify HIV and syphilis testing patterns over the last decade.
Children’s population discovery tool-Grandpop was used to compare Children’s ED HIV and syphilis testing volumes of patients 13–24-year-olds, from January 1, 2013, to December 31, 2023. Data was categorized by sex, positive results, mean age, and positivity rate. Descriptive statistics were utilized.
During the decade, 9283 patients were tested for syphilis, 7056(76%) females and 2227(24%) males, mean age16.0± 0.3. There were 203 positives, 138(68%) females and 65(32%) males, positivity rate of 2.2%. A higher prevalence was found in males (2.9%) vs females (1.9%). For HIV, 11,055 patients were tested, 8037(73%) females and 3018(27%) males, mean age,16.0± 0.2. There were 61 positives, 8(13%) females and 53(87%) males, positivity rate of 0.6%. Testing from 2013 to 2023 increased >7-fold for HIV and syphilis with a strong correlation (r= .98, P<0.001); screening increase was seen after the BPA launch. For positive results, HIV more than doubled while syphilis increased 8-fold when comparing 2013 to 2023.
This reveals a high prevalence of syphilis. Screening in the ED plays a pivotal role in identifying this public health crisis. Earlier detection, linkage to care and preventative resources are components that can target syphilis and HIV rates. The CDC should consider recommending opt-out syphilis testing given the growing disease burden.
