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RESEARCH ARTICLE (Open Access)

An outbreak-driven emergency department screening program for syphilis in North Queensland’s Aboriginal and Torres Strait Islander population

Leah Moncrieff https://orcid.org/0009-0006-7671-6808 A * , Luke Lawton B , Leanne Hall A , Katie Edmondson C , Arun Menon D and Clare Heal A
+ Author Affiliations
- Author Affiliations

A College of Medicine and Dentistry, James Cook University, JCU Mackay Clinical School, Ngudya Yamba Campuses, Building K Level 1, Mackay Base Hospital, 475 Bridge Road, Mackay, Qld 4740, Australia.

B Emergency Department, Townsville University Hospital, 100 Angus Smith Drive, Douglas, Townsville, Qld 4814, Australia.

C Women’s Reproductive Health Service, Townsville Hospital and Health Service, 100 Angus Smith Drive, Douglas, Townsville, Qld 4814, Australia.

D Townville Sexual Health Service, Townsville University Hospital, 100 Angus Smith Drive, Douglas, Townsville, Qld 4814, Australia.


Handling Editor: Ian Simms

Sexual Health 22, SH25055 https://doi.org/10.1071/SH25055
Submitted: 31 March 2025  Accepted: 3 September 2025  Published: 25 September 2025

© 2025 The Author(s) (or their employer(s)). Published by CSIRO Publishing. This is an open access article distributed under the Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License (CC BY-NC-ND)

Abstract

Background

There is an ongoing syphilis outbreak in regional and rural areas of Australia, with Aboriginal and Torres Strait Islander peoples disproportionately represented in notification data. Innovative screening approaches are needed in healthcare settings frequented by at-risk communities. The emergency department (ED) was hypothesised to be an ideal location for screening Aboriginal and Torres Strait Islander peoples, who traditionally underutilise healthcare services.

Methods

A quality improvement initiative introduced an opt-out syphilis screening program at the Townsville University Hospital ED. For Aboriginal and Torres Strait Islander clients aged 15–40 years, syphilis screening was automatically added to blood tests collected as part of routine care. A retrospective audit of the program assessed screening rates, diagnosis, linkage to treatment and contact tracing outcomes.

Results

The program added 5471 tests for 3942 individuals within the target age range. Twenty-seven Aboriginal and Torres Strait Islander peoples were diagnosed with syphilis infections requiring treatment, indicating a 0.68% prevalence. The odds of untreated syphilis were significantly higher in the oldest age group (aged 36–40 years) compared with the youngest age group (aged 15–20 years; OR 3.88, 95% CI 1.05–14.40, P = 0.04). All diagnoses of late latent or syphilis of unknown duration (n = 5) were made in the oldest age group. One pregnant woman was diagnosed with early syphilis. All infections, except one, were successfully treated by sexual health services.

Conclusion

The ED screening program effectively identified undetected syphilis cases in the Aboriginal and Torres Strait Islander population. This audit informed future adaptations to the program, including expanding the target age range and increasing the screening interval between tests. Similar ED syphilis screening protocols could be adopted by other hospitals in syphilis outbreak areas.

Keywords: Australian Aboriginal and Torres Strait Islander peoples, clinical audit, emergency service, mass screening, quality improvement, sexual health, sexually transmitted infections, syphilis.

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