Emergency Department Syphilis Screening: Insights from a National Stakeholder Convening

The United States is experiencing a prolonged syphilis epidemic, with high rates of infection and increasing cases of congenital syphilis. Despite these trends, there is no coordinated national approach to syphilis screening outside of pregnancy, and many individuals at highest risk lack access to routine outpatient care. Emergency departments (EDs), which serve as a critical safety net for populations at highest risk of syphilis and its complications, represent an important and underutilized setting for syphilis screening. To address this gap, a national convening of multidisciplinary experts was organized by the Emergency Medicine Transmissible Infectious Diseases and Epidemics consortium, with support from the Centers for Disease Control and Prevention and the National Association of County and City Health Officials. Participants reviewed available evidence and shared implementation experience to identify feasible and effective strategies for ED-based syphilis screening. Inperson discussion was followed by iterative review and revision of manuscript drafts until consensus was achieved. A tiered framework for ED syphilis screening is proposed, including universal, population-focused, and minimum screening strategies, allowing adaptation to local resources and epidemiology. Key operational considerations include consent processes, laboratory testing approaches, electronic health record integration, and systems for follow-up and treatment. Successful implementation requires infrastructure beyond the ED, including partnerships with public health agencies, supportive policy, and sustainable financing. ED-based syphilis screening represents a critical opportunity to improve early detection, reduce transmission, and prevent congenital syphilis. Coordinated national guidance and investment are needed to support widespread adoption and maximize public health impact.