Syphilis screening to follow‐up: Role of social determinants in pregnant patients visiting the emergency department

Abstract Introduction Emergency departments (EDs) offer a critical opportunity to identify syphilis during pregnancy. However, patient factors that influence test uptake and follow‐up remain understudied. This study evaluates the role of social determinants of health (SDOH) in syphilis test completion and linkage to prenatal care among pregnant ED patients. Methods After Institutional Review Board approval, a prospective cohort study was conducted at the University of Texas Health Science Center in Houston, TX. Pregnant patients presenting to the ED between November 5, 2024 and June 1, 2025 were offered opt‐out syphilis testing and linkage to prenatal care. Key SDOH variables included race/ethnicity, primary language, insurance type, prenatal care status, partner presence, and substance use. Multivariable logistic regression identified predictors of test completion and prenatal care follow‐up. Results Of 230 patients approached, 181 (78%) underwent testing. Hispanic patients were significantly more likely to complete testing than non‐Hispanic White patients (odds ratio [OR], 13.6; 95% confidence interval [CI], 1.5–308.6; p = 0.036), while patients who identified Spanish as their primary language were less likely (OR, 0.11; 95% CI, 0.006–0.68; p = 0.046). Patients without prenatal care were more likely to complete testing (OR, 0.31; 95% CI, 0.14–0.66; p = 0.003), and those with Medicaid (OR, 0.38; 95% CI, 0.16–0.87; p = 0.024) or self‐pay status (OR, 0.19; 95% CI, 0.07–0.50; p = 0.001) were less likely to complete testing compared to privately insured patients. Among tested participants, 88 (49.4%) followed up with prenatal care. Patients who identified Spanish as their primary language (OR, 0.24; 95% CI, 0.08–0.69; p = 0.010) and self‐pay patients (OR, 0.13; 95% CI, 0.04–0.36; p < 0.001) had lower odds of follow‐up. Prenatal care, partner presence, and substance use were not significantly associated with testing completion or follow‐up prenatal visits. Conclusion Preferred language, insurance status, and ethnicity impact test uptake and prenatal care follow‐up. Addressing these communication and financial barriers may help reduce disparities in perinatal syphilis care.