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Poster Session 4

Category: Infectious Diseases

Poster Session 4

(1120) Screening on Arrival: A Decision Analysis of Universal Syphilis Screening in Pregnant Emergency Department Patients

Thursday, February 12, 2026

3:30 PM - 5:00 PM

Submitting Author and Presenting Author(s)

Jennifer Qin, MD (she/her/hers)

Maternal Fetal Medicine Fellow
University of Washington
Seattle, Washington, United States

Coauthor(s)

Leah M. Savitsky, MD (she/her/hers)

MFM Fellow
University of Washington
Seattle, Washington, United States
Catherine M. Albright, MD, MS (she/her/hers)

Associate Professor, Maternal-Fetal Medicine
University of Washington
Seattle, Washington, United States

Objective:
Congenital syphilis is rising sharply in the United States, with many affected birth parents receiving inadequate prenatal care prior to delivery. A recent study demonstrated universal, opt-out syphilis screening in the emergency department (ED) identifies a substantial burden of previously undiagnosed infection. Because ED encounters may be the only point of care for some patients, we evaluated the optimal strategy of syphilis screening for pregnant patients presenting to the ED.

Study Design:
We constructed a Markov decision model comparing universal ED screening with testing only when clinically indicated, with a base case maternal syphilis prevalence of 700/100,000 for an urban ED population. Up to four additional ED visits were modeled if the patient remained untreated and undelivered. The primary outcome was cost to prevent a case of congenital syphilis, with secondary outcomes including intrauterine fetal demise (IUFD), neonatal demise, and cases of treated syphilis. Some patients were assumed to seek routine prenatal care following an ED visit and receive testing and treatment in that setting. One-way and probabilistic sensitivity analyses were used to assess the robustness of conclusions.

Results:
In a theoretical cohort of 100,000 patients, universal screening for syphilis in the ED is expected to marginally decrease overall costs, identify and treat more pregnant patients with syphilis, and decrease the incidence of congenital syphilis and perinatal loss. The theoretical cost savings of preventing one case of congenital syphilis was $549,470. This strategy remains cost-saving until the prevalence of syphilis decreases to a rate less than 10.2/100,000 people. The model was sensitive to the probability of syphilis in the population, the probability that a patient completes treatment, and the likelihood of IUFD in the setting of congenital syphilis.

Conclusion:
Universal ED screening is a cost-saving strategy to decrease the incidence of congenital syphilis. Given the US national maternal syphilis rate of 280/100,000 births, this strategy should be strongly considered.