Syphilis Point of care Testing in tertiary Emergency Department setting: Implementation and Impact on care of Women (SPOTED)

The two study cohorts are 1) all pregnant women and 2) women of reproductive age (18-45), undergoing clinical assessment that includes the need for sexually transmitted infection (STI) testing, presenting to a tertiary emergency department (ED). These two cohorts will be offered enrolment in the study. The study will involve all consenting participants having syphilis serology blood testing done as well as undergoing a single syphilis point of care test (syPOCT). The syPOCT will be the Australian TGA approved Abbott Determine Syphilis TP. The syPOCT will be performed on a finger prick blood sample by an ED nurse who is part of the SPOTED study team and has undergone training in performing and interpreting this syPOCT. Each participant will undergo one valid, interpretable syPOCT test during their current ED admission. The syPOCT result will be read 15 minutes after it has been collected and results will be documented in patient notes and communicated with treating ED medical officer. If the result is positive, the participant will be counselled on the result, the Queensland Syphilis Surveillance Register will be contacted to obtain previous testing and treatment history and in consultation with Infectious diseases consultant a decision will be made to offer treatment for syphilis in the ED. SPOTED study team will review all syphilis serology for consenting participants within 7 days from patient enrolement in the study. Regardless of syPOCT result (ie positive and negative) all participants will be reviewed in the Infectious Diseases outpatient clinic within 2 weeks from their index ED presentation during which the syPOCT was performed. During that clinic visit, syphilis serology results will be reviewed and a further offer of treatment made if appropriate and treatment will be administered if participant consents to this. All SPOTED study team members will undergo specific training in use of the syPOCT device. maintain a training log, check lot expiry dates and document their results in a data sheet which we reviewed every month by the study PI. In addition, where there is uncertainty regarding the interpretation of a syPOCT test result the SPOTED study team member will check with a second team member to ensure the result is being interpretated correctly. Adherence to the intervention is confirmed each time a completed CRF is collected by a study team member and any concerns for non-adherence will be discussed by PI with study team.