Geospatial Analysis of Primary Care Gaps and Syphilis Screening: Public Health Implications in the Hampton Roads Region of Virginia and North Carolina.
Poster #: 143
Session/Time: B
Author:
Martina Zamponi, PhD, MS
Mentor:
Peter Anthony Mollica, PhD
Research Type: Public Health
Abstract
INTRODUCTION:
Syphilis, caused by Treponema pallidum, has re-emerged as a major public health concern in the United States. Infection rates have been steadily increasing since the early 2000s and disproportionately affect marginalized populations and those with limited access to healthcare. In 2023, over 209,000 cases were reported nationwide, with Virginia experiencing a 22% increase since the previous year. The Hampton Roads region of Virginia and North Carolina is particularly affected, with 7 of its 9 independent cities exceeding the CDC's threshold for recommended screening. Social determinants of health, including low income, lack of health insurance, limited access to healthcare, and racial/ethnic minority status, have been consistently linked to increased rates of sexually transmitted infections. However, no prior study has examined the relationship between primary care access and syphilis outcomes in this region.
METHODS:
A retrospective cohort study was conducted using TriNetX data from the Sentara network. Electronic Health Record data from over 4 million patients were collected within the Sentara Healthcare Organization. This database was chosen due to Sentara's dominant presence within the Hampton Roads region, encompassing 12 acute care hospitals and over 300 care sites, providing a comprehensive representation of the local patient population. Patients diagnosed with syphilis between 2023-2024 were identified using ICD-10 diagnosis codes. These were then stratified by emergency department (ED) utilization: occasional ED users (<4 visits/year) and chronic ED users (≥4 visits/year), the latter serving as a proxy for limited access to primary care. Demographics, stage of syphilis at diagnosis, and tertiary syphilis complications were compared between groups. Age distribution was tested for normality, and chi-square analysis with odds ratios was used to assess statistical significance (p<0.05).
RESULTS:
Among 1,560 syphilis patients identified, 310 were chronic ED users. African American patients were significantly overrepresented in the chronic ED group (74.2% vs. 56.0%, p<0.0001). Chronic ED users were more likely to be diagnosed with late syphilis (OR=1.44, p=0.0076), latent late syphilis (OR=1.54, p=0.0283), and asymptomatic neurosyphilis (OR=4.13, p=0.0023). Age distribution was normal in the occasional ED group but skewed in chronic ED users group, with a higher proportion within the CDC's screening target of 15-44 years (55.2% vs. 50.8%).
CONCLUSION:
Reduced access to primary care is associated with more advanced syphilis at diagnosis and greater risk of tertiary complications in Hampton Roads, disproportionately affecting African American populations. Expanding syphilis screening criteria to include markers of healthcare access rather than age may improve early detection, reduce disparities, and prevent long-term complications. Targeted public health interventions that integrate access-based screening with broader STI prevention strategies could help mitigate the ongoing rise of syphilis in high-burden regions.
Syphilis, caused by Treponema pallidum, has re-emerged as a major public health concern in the United States. Infection rates have been steadily increasing since the early 2000s and disproportionately affect marginalized populations and those with limited access to healthcare. In 2023, over 209,000 cases were reported nationwide, with Virginia experiencing a 22% increase since the previous year. The Hampton Roads region of Virginia and North Carolina is particularly affected, with 7 of its 9 independent cities exceeding the CDC's threshold for recommended screening. Social determinants of health, including low income, lack of health insurance, limited access to healthcare, and racial/ethnic minority status, have been consistently linked to increased rates of sexually transmitted infections. However, no prior study has examined the relationship between primary care access and syphilis outcomes in this region.
METHODS:
A retrospective cohort study was conducted using TriNetX data from the Sentara network. Electronic Health Record data from over 4 million patients were collected within the Sentara Healthcare Organization. This database was chosen due to Sentara's dominant presence within the Hampton Roads region, encompassing 12 acute care hospitals and over 300 care sites, providing a comprehensive representation of the local patient population. Patients diagnosed with syphilis between 2023-2024 were identified using ICD-10 diagnosis codes. These were then stratified by emergency department (ED) utilization: occasional ED users (<4 visits/year) and chronic ED users (≥4 visits/year), the latter serving as a proxy for limited access to primary care. Demographics, stage of syphilis at diagnosis, and tertiary syphilis complications were compared between groups. Age distribution was tested for normality, and chi-square analysis with odds ratios was used to assess statistical significance (p<0.05).
RESULTS:
Among 1,560 syphilis patients identified, 310 were chronic ED users. African American patients were significantly overrepresented in the chronic ED group (74.2% vs. 56.0%, p<0.0001). Chronic ED users were more likely to be diagnosed with late syphilis (OR=1.44, p=0.0076), latent late syphilis (OR=1.54, p=0.0283), and asymptomatic neurosyphilis (OR=4.13, p=0.0023). Age distribution was normal in the occasional ED group but skewed in chronic ED users group, with a higher proportion within the CDC's screening target of 15-44 years (55.2% vs. 50.8%).
CONCLUSION:
Reduced access to primary care is associated with more advanced syphilis at diagnosis and greater risk of tertiary complications in Hampton Roads, disproportionately affecting African American populations. Expanding syphilis screening criteria to include markers of healthcare access rather than age may improve early detection, reduce disparities, and prevent long-term complications. Targeted public health interventions that integrate access-based screening with broader STI prevention strategies could help mitigate the ongoing rise of syphilis in high-burden regions.