Using Syndromic Surveillance (SS) to Improve Sexually Transmitted Disease (STD) Surveillance and Adherence to Treatment Guidelines in Philadelphia

Background:
Like many health departments, the Philadelphia Department of Public Health (PDPH) receives data from 23 local hospitals to monitor disease trends for Emergency Preparedness.

Objective:
To describe how a SS system can be used in conjunction with STD surveillance systems to assure timeliness and completeness of reporting. To describe how the system may be helpful in providing other crucial information about STD treatment in private facilities.

Method:
Since 2003, PDPH has conducted daily analyses of chief complaint and discharge data from various EDs. Those that contain reportable disease information are flagged and are reviewed by PDPH staff. Suspect and confirmed cases of reportable diseases are forwarded to program personnel. We reviewed cases that indicated syphilis as a reason for the encounter and evaluated this system for case finding.

Result:
Since implementation of SS, 19 possible syphilis cases have been forwarded for review. Of these, 10 were not cases of syphilis based upon serological tests. One was forwarded to another jurisdiction and the diagnosis is unknown. Eight were confirmed cases; 2 were new cases not previously known to PDPH. The other six had been reported previously or on the same date discovered through SS. Review of medical records for a patient whose chief complaint was “STD exposure,” revealed non-therapeutic treatment for gonorrhea based upon revised STD Treatment Guidelines published in April 2007.

Conclusion:
ED surveillance data may be used as an additional method of surveillance to assure complete and timely disease reporting. It may also help to identify lapses in clinical protocols where a Health Department intervention may be necessary.

Implications:
Partnering with Public Health Preparedness Programs, are helpful in assuring surveillance programs are thorough and timely. Information may identify gaps in communications with other health care agencies that warrant additional follow-up.