question: ABSTRACT: The impact of the COVID-19 pandemic on syphilis rates is unknown. A retrospective chart review was performed of all patients screened for syphilis through universal screening in a large, urban emergency department from June 2019 to June 2020. During the early pandemic (April through June 2020), screening rates remained similar, but the rate of presumed active infection increased from 1.2% to 1.8% (prevalence ratio, 1.54; 95% confidence interval, 1.17-2.00; P < 0.01), with significant increases among adolescents and women. Only 19.2% of patients with presumed active infection presented for STI-related complaints. Universal screening represents a valuable tool for achieving syphilis control within high-prevalence communities.