Factors Associated With Repeat Syphilis Testing at a Large Urban LGBT Health Clinic: Chicago, IL 2002-2008

At six and 12 months after diagnosis with early syphilis, CDC recommends clinical and serologic re-evaluation to determine treatment efficacy.

The researchers conducted the current retrospective cohort study of men who have sex with men enrolled in primary care at a lesbian, gay, bisexual and transgender health center. The team used multivariable Poisson regression to examine associations between patient characteristics and timely follow-up (returning to the clinic within six months of initial diagnosis) -- and among patients with timely follow-up, factors associated with rescreening at the follow-up visit.

From January 2002 to December 2008, the clinic performed 5,788 syphilis tests. A total of 256 (4.4 percent) early syphilis cases were detected among 225 men. Of the 225 men, 134 (59.6 percent) received timely follow-up. Following implementation of electronic medical records and enhanced disease intervention specialist (DIS) follow-up, timely follow-up rose from 53 percent to 76 percent, while rescreening increased from 64 percent to 81 percent. Timely follow-up was more likely for HIV-positive men (adjusted relative risk=1.93; 95 percent confidence interval 1.31-2.85) and for patients diagnosed in 2007-08 (ARR=1.28; 95 percent CI: 1.04-1.57).

Among those patients who did receive timely follow-up, 94 (70 percent) were rescreened for syphilis. Diagnosis in 2007-08 was associated with a greater likelihood of rescreening at follow-up (ARR=1.24; 95 percent CI: 1.00-1.53).

"Timely follow-up and rescreening improved during the study period, subsequent to implementation of electronic medical records and enhanced DIS follow-up," the authors concluded. "Even in this later period, the combination of lack of timely follow-up and rescreening resulted in 39 percent of patients without CDC-recommended follow-up. Further efforts are needed to improve timely follow-up by patients and rescreening by clinicians."

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