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Introduction: Syphilis is associated with increased risk of cerebrovascular disease and acute stroke; stroke may even be the initial clinical manifestation of syphilis (Images 1 and 2). In the United States, syphilis rates have been increasing at an alarming rate since 2000, and between 2018-2022 cases increased by nearly 80%. Knowing the infectious status of a patient changes acute and secondary stroke management strategies, and widespread screening is imperative toward national eradication efforts. This study aims to explore syphilis laboratory screening trends in hospitalized stroke patients, whether rates of screening have risen with increases in national cases, and which demographic factors predict screening. Hypothesis: We hypothesized that 1) overall screening for syphilis in acute stroke is low, especially in comparison to screening for diabetes and hyperlipidemia, 2) screening rates increase annually from 2016-2020, and 3) screening for syphilis occurs more often in younger and minority patients. Methods: We reviewed all stroke admissions from a US comprehensive stroke center between 2016-2020 and collected syphilis laboratory data and patient demographics. Of patients without known history of syphilis, we evaluated screening rates of syphilis and compared to that of Hemoglobin A1c (HbA1c) or Low-Density Lipoprotein (LDL) for this period with Student’s t-test. We used logistic regression to determine the relationship between screening rates of syphilis and patient age and race. Results: Between 2016-2020, there were 5,653 stroke admissions without established infection. The average annual screening rate of syphilis (1.19%) was significantly lower than that of HbA1c (58%; p=0.002) and LDL (69.0%; p<0.001). Annual screening rates increased from 0.44% to 2.5% between 2016-2019, but then dropped to 1.02% in 2020. Age at admission was inversely correlated with syphilis screening (p<0.001) and minority status was associated with higher syphilis screening (p<0.001). Conclusions: Syphilis screening rates in the acute stroke setting are low overall and have not increased over time despite continued rises in national infections in the US. Younger and racial minority patients are more likely to be screened. Future work is needed to examine if enhanced syphilis screening practices in acute stroke hospitalizations can be used to inform stroke management and improve patient outcomes.