Frequent emergency department utilization and syphilis case profiles in the Sentara healthcare system: a retrospective cross-sectional analysis in Hampton Roads

Abstract Background Syphilis rates have increased substantially nationwide, disproportionately affecting marginalized populations and individuals with differing patterns of healthcare utilization. The Hampton Roads region of Virginia and North Carolina includes multiple jurisdictions with syphilis rates above the CDC screening threshold, with 7 of its 9 independent cities meeting this criterion. However, no prior study has examined the relationship between emergency department (ED) utilization patterns and documented syphilis diagnoses in this region. Methods A retrospective cross-sectional analysis of the Sentara Healthcare network was conducted using aggregate data from the TriNetX platform. Patients diagnosed with syphilis between 2023 and 2024 were stratified by ED utilization frequency using two utilization thresholds: occasional ED users (< 4 or < 6 visits/year) and frequent ED users (≥ 4 or ≥ 6 visits/year). Demographic characteristics, syphilis stage distributions, and tertiary syphilis–related diagnoses were compared between groups using chi-square and normality testing. Results Among 1,640 patients with documented syphilis diagnoses, 330 were classified as frequent ED users using the ≥ 4 ED visit threshold, and 170 using the ≥ 6 ED visit threshold. African American patients were significantly overrepresented in both frequent ED utilization groups compared with occasional ED users (69.69% vs. 56.48%, and 76.47% vs. 57.82%, respectively). Frequent ED users demonstrated higher proportions of documented late syphilis, latent late syphilis, and certain tertiary syphilis–related diagnoses. Overall differences in syphilis stage distribution and tertiary syphilis sequelae were more pronounced in sensitivity analyses using the ≥ 6 ED utilization threshold. Conclusions Patients with higher levels of ED utilization demonstrated differing patterns of documented syphilis diagnoses, including higher proportions of certain late-stage and tertiary syphilis–related diagnoses, within this regional healthcare system. These findings may reflect differences in healthcare utilization patterns, screening practices, healthcare engagement, or diagnostic coding practices across patient populations. Further research using individual-level and longitudinal data is needed to better characterize factors associated with documented syphilis diagnosis patterns within the region.