ORCID

0000-0002-9154-1667 (Zamponi), 0009-0008-0337-7619 (Tillotson), 0009-0005-6658-0292 (Knox), 0000-0002-1100-8310 (Tardif-Kunk), 0000-0002-0621-2819 (Mollica)

Document Type

Article

Publication Date

2026

DOI

10.1186/s12889-026-27785-4

Publication Title

BMC Public Health

Volume

Advance online publication

Pages

22 pp.

Abstract

Background

Syphilis rates have increased substantially nationwide, disproportionately affecting marginalized populations and individuals with differing patterns of healthcare utilization. The Hampton Roads region of Virginia and North Carolina includes multiple jurisdictions with syphilis rates above the CDC screening threshold, with 7 of its 9 independent cities meeting this criterion. However, no prior study has examined the relationship between emergency department (ED) utilization patterns and documented syphilis diagnoses in this region.

Methods

A retrospective cross-sectional analysis of the Sentara Healthcare network was conducted using aggregate data from the TriNetX platform. Patients diagnosed with syphilis between 2023 and 2024 were stratified by ED utilization frequency using two utilization thresholds: occasional ED users (<  4 or <  6 visits/year) and frequent ED users (≥ 4 or ≥ 6 visits/year). Demographic characteristics, syphilis stage distributions, and tertiary syphilis-related diagnoses were compared between groups using chi-square and normality testing.

Results

Among 1,640 patients with documented syphilis diagnoses, 330 were classified as frequent ED users using the ≥ 4 ED visit threshold, and 170 using the ≥ 6 ED visit threshold. African American patients were significantly overrepresented in both frequent ED utilization groups compared with occasional ED users (69.69% vs. 56.48%, and 76.47% vs. 57.82%, respectively). Frequent ED users demonstrated higher proportions of documented late syphilis, latent late syphilis, and certain tertiary syphilis-related diagnoses. Overall differences in syphilis stage distribution and tertiary syphilis sequelae were more pronounced in sensitivity analyses using the ≥ 6 ED utilization threshold.

Conclusions

Patients with higher levels of ED utilization demonstrated differing patterns of documented syphilis diagnoses, including higher proportions of certain late-stage and tertiary syphilis-related diagnoses, within this regional healthcare system. These findings may reflect differences in healthcare utilization patterns, screening practices, healthcare engagement, or diagnostic coding practices across patient populations. Further research using individual-level and longitudinal data is needed to better characterize factors associated with documented syphilis diagnosis patterns within the region.

Rights

© The Authors 2026

This article is licensed under a Creative Commons Attribution 4.0 International (CC BY 4.0) License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original authors and the source, provide a link to the Creative Commons license, and indicate if changes were made. The images or other third party material in this article are included in the article’s Creative Commons license, unless indicated otherwise in a credit line to the material. If material is not included in the article’s Creative Commons license and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. 

Data Availability

Article states: "The data that support the findings of this study are available from TriNetX and Sentara Health, but restrictions apply to the availability of these data, which were used under license for the current study, and so are not publicly available. Data are, however, available from the authors upon reasonable request and with permission of Sentara Health."

Original Publication Citation

Zamponi, M., Tillotson, G. M., Knox, C. F., Tardif-Kunk, M., Campbell, T. R., & Mollica, P. A. (2026). Frequent emergency department utilization and syphilis case profiles in the Sentara healthcare system: A retrospective cross-sectional analysis in Hampton Roads. BMC Public Health. Advance online publication. https://doi.org/10.1186/s12889-026-27785-4

Additional Files
12889_2026_27785_MOESM1_ESM.docx (17 kB)
Additional File 1: Table S1
12889_2026_27785_MOESM2_ESM.docx (17 kB)
Additional File 2: Table S2
Download

Share

COinS