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Introduction: The incidence of sexually transmitted infections (STI) increased in the United States between 2017-2021. There is limited data describing STI co-testing practices and the prevalence of STI co-infections in emergency departments (ED). In this study, we aimed to describe the prevalence of co-testing and co-infection of HIV, hepatitis C virus (HCV), syphilis, gonorrhea, and chlamydia, in a large, academic ED., Methods: This was a single-center, retrospective cross-sectional study of ED patients tested for HIV, HCV, syphilis, gonorrhea or chlamydia between November 27, 2018-May 26, 2019. In 2018, the study institution implemented an ED-based infectious diseases screening program in which any patient being tested for gonorrhea/chlamydia was eligible for opt-out syphilis screening, and any patient 18-64 years who was having blood drawn for any clinical purpose was eligible for opt-out HIV and HCV screening. We analyzed data from all ED patients ≥13 years who had undergone STI testing. The outcomes of interest included prevalence of STI testing/co-testing and the prevalence of STI infection/co-infection. We describe data with simple descriptive statistics., Results: During the study period there were 30,767 ED encounters for patients ≥13 years (mean age: 43 ± 14 years, 52% female), and 7,866 (26%) were tested for at least one of HIV, HCV, syphilis, gonorrhea, or chlamydia. We observed the following testing frequencies (and prevalence of infection): HCV, 7,539 (5.0%); HIV, 7,359 (0.9%); gonorrhea, 574 (6.1%); chlamydia, 574 (9.8%); and syphilis, 420 (10.5%). Infectious etiologies with universal testing protocols (HIV and HCV) made up the majority of STI testing. In patients with syphilis, co-infection with chlamydia (21%, 9/44) and HIV (9%, 4/44) was high. In patients with gonorrhea, co-infection with chlamydia (23%, 8/35) and syphilis (9%, 3/35) was high, and in patients with chlamydia, co-infection with syphilis (16%, 9/56) and gonorrhea (14%, 8/56) was high. Patients with HCV had low co-infection proportions (<2%)., Conclusion: Prevalence of STI co-testing was low among patients with clinical suspicion for STIs; however, co-infection prevalence was high in several co-infection pairings. Future efforts are needed to improve STI co-testing rates among high-risk individuals., Competing Interests: Conflicts of Interest: By the WestJEM article submission agreement, all authors are required to disclose all affiliations, funding sources and financial or management relationships that could be perceived as potential sources of bias. This work was supported by Gilead-funded Frontlines of Communities in the United States (FOCUS). The FOCUS Program is a public health initiative that enables partners to develop and share best practices in routine blood-borne virus (HIV, HCV, HBV) screening, diagnosis, and linkage to care in accordance with screening guidelines promulgated by the US Centers for Disease Control and Prevention, the US Preventive Services Task Force (USPSTF), and state and local public health departments. FOCUS funding supports HIV, HCV, and HBV screening and linkage to the first medical appointment after diagnosis. FOCUS partners do not use FOCUS awards for activities beyond linkage to the first medical appointment. There are no other conflicts of interest or sources of funding to declare.

Background Syphilis incidence across all regions of California increased by 22% compared with 2016 cases; with the largest number of chlamydia, gonorrhea, syphilis, and congenital syphilis cases among all states (CDC 2017). The USPSTF recommends targeted syphilis screening in patients at increased risk. However, in emergency departments (EDs) targeted syphilis screening is not routinely performed even when patients present for concerns of a sexually transmitted infection (STI). The purpose of this program was to implement routine syphilis screening among ED patients being tested for chlamydia and gonorrhea (CT/GC) through the use of an EHR enhancement to maximize the number of new syphilis diagnoses. Methods From November 27, 2018 to March 31, 2019, EHR-based syphilis screening was implemented in a quaternary care ED in Northern California serving urban and rural populations. EMR best practice alerts (BPA) were developed and populated on patients receiving STI testing. Syphilis testing employed a reverse sequence algorithm, which is suggested for high prevalence settings and provides rapid turnaround time. Patients were excluded if they opted out from testing. We determined the proportion of all CT/GC tested patients who underwent syphilis screening and the prevalence of syphilis among this group. Results During a four-month period, 649 ED patients with suspected STI received a BPA to screen for syphilis. Of those, 425 patients (65.5%) were screened for syphilis, 22 had a reactive IgG/IgM and RPR, while 5 patients had a reactive IgG/IgM and a nonreactive RPR which required a TPPA test to detect their infection. Fourteen of the 22 patients with a reactive RPR had titers of 1:32 or higher. Nine (32%) of those with a positive CT/GC test tested positive for syphilis. Conclusion Implementation of a syphilis screening program in patients undergoing testing for other STIs yielded 28 new diagnoses compared with those tested prior to the screening in 2018. Introducing an automated EMR-based syphilis screening program is an effective method to maximize syphilis screening in all ED patients seeking treatment for STIs. The screening data suggest that the majority of patients undergoing STI testing in our ED are not screened for syphilis, yet the prevalence of infection in those screened is substantial. Disclosures All authors: No reported disclosures. [ABSTRACT FROM AUTHOR]