TOPLINE:

Among about 5.6 million patients with symptomatic encounters suggestive of sexually transmitted infections (STIs), only 37.8% received testing in emergency departments (EDs) in the US, a study showed. Testing for Neisseria gonorrhoeae/Chlamydia trachomatis (NG/CT) was most common, whereas rates of HIV and syphilis testing remained low.

METHODOLOGY:

• Researchers conducted a retrospective cohort study and analyzed 5,566,966 ED encounters from 2016 through 2024, using data from the Cosmos Slicer Dicer research platform.
• The cohort comprised patients aged 15 years or older who presented to US EDs with chief complaints suggestive of STIs; of them, 37.5% were aged 40 years or older, 61.5% were women, and 54.7% were White individuals.
• Diagnostic testing rates for NG/CT, Trichomonas vaginalis/bacterial vaginosis (TV/BV), syphilis, HIV, and pregnancy were examined using Current Procedural Terminology codes.
• The primary objective was to evaluate temporal trends in STI testing and empiric treatment. The secondary objective was to assess demographic variation in testing rates and the extent of co-testing for other STIs among those tested for NG/CT.

TAKEAWAY:

• Among patients who presented to the ED with symptoms suggestive of STIs, only 37.8% underwent any ED testing for STIs. NG/CT testing was most frequent (34.1% of encounters), followed by TV/BV testing (21.7%), whereas rates of HIV and syphilis testing remained low (4.1% and 3.9%, respectively).
• Co-testing was limited: among those tested for NG/CT, 56.0% were also tested for TV/BV, but only 9.3% and 8.5% received syphilis and HIV testing, respectively; pregnancy testing occurred in 68.5% of eligible women.
• Empiric antibiotic treatment was administered to 46.2% of patients tested for NG/CT, with rates peaking at 53.2% in 2020 before declining to 40.6% in 2024.
• Among patients tested for TV/BV, 13.4% received empiric treatment in the ED, whereas 32.4% were prescribed outpatient treatment.

IN PRACTICE:

"These findings underscore the need for standardized approaches to ED-based STI care that prioritize comprehensive testing, appropriate empiric treatment, and alignment with public health goals. The ED remains a critical access point for STI diagnosis and management, and targeted interventions to strengthen testing and treatment practices in this setting have the potential to improve patient outcomes and reduce transmission at the population level," the authors wrote.

SOURCE:

The study was led by Michael Gottlieb, MD, Rush University Medical Center, Chicago. It was published online on January 02 in The American Journal of Emergency Medicine.

LIMITATIONS:

The study was limited by the use of the Cosmos platform (with data restricted to the Epic system), which may not have reflected national patterns. The use of chief complaints for patient identification may have introduced selection bias, as it may have missed cases in which patients did not disclose symptoms to triage nurses. The authors did not have access to laboratory results and could not assess positivity rates, preventing the evaluation of the appropriateness of empiric treatment. Additionally, the combination of TV/BV as a single test in the database limited the individual analysis of these conditions.

DISCLOSURES:

The study received no funding, and the authors reported having no conflicts of interest.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.