WP 68 Syphilis Screening Among MSM at an Urban Urgent Care Center: A Quality Improvement Initiative

Wednesday, September 21, 2016
Galleria Exhibit Hall
Dina L. Romo, MD, Department of Pediatrics, Division of Child and Adolescent Health, Columbia University Medical Center; New York Presbyterian Hospital, New York, NY, Sarah Schechter, BA, Columbia College of Physician and Surgeons, New York, NY, Alwyn Cohall, MD, Columbia University Medical Center, New York, NY and Natalie Neu, MD, MPH, Department of Pediatrics, Infectious Diseases, Columbia University Medical Center, New York, NY

Background: Men who have sex with men (MSM) have a high risk of syphilis which increases their risk for acquiring and transmitting HIV. MSM lack consistent access to healthcare and rely on urgent care centers (UCC). This presents an opportunity for syphilis screening which is not routine in this setting. This quality-improvement initiative implemented a brief sexual history (SH) questionnaire to facilitate MSM self-identification to aid in syphilis screening.

Methods: A UCC (n=906 males) was identified where 15.7% of clients had a chief complaint of possible STI infection (Genitourinary, rectal, rash, sexual-health complaint) but only 8.1% had SH documented; only 0.8% self-identified as MSM. To increase identification of MSM and syphilis testing, an intervention was implemented after conducting a focus group which identified STI screening barriers such as lack of time and discomfort asking routine sexual history questions. The intervention included an STI lecture on screening for MSM and administration of a brief SH questionnaire aimed at identifying same-sex sexual behavior. Two 12-week cycles were evaluated for questionnaire completion, MSM identification and syphilis testing. Electronic medical records (EMR) were reviewed for all males (age 18-55) to determine rates of SH documentation and syphilis testing.  Descriptive statistics were used for analysis.

Results: During the intervention period, 1793 males were seen, of whom, 33.5% completed the questionnaire and 12.0% self-identified as MSM (n=72). Of MSM, 61.0% reported symptoms indicative of a STI and 78% agreed to STI screening (n=56).  Of those requesting screening, only 65.9% were tested for syphilis (n=37) of which 10.8% (n=4) were positive. Despite questionnaire identification of MSM, only 65.2% had SH documented in their EMR.

Conclusions: Implementing SH questionnaires in a UCC is feasible and may help identify MSM for syphilis testing.  Further work needs to be done with providers and MSM to help identification of high risk behaviors and syphilis screening.