TOPLINE:

Integrating a rapid point-of-care polymerase chain reaction (PCR) testing for sexually transmitted infections (STIs) in the emergency department (ED) reduced the length of stay of patients by 76 minutes and substantially reduced the rates of overtreatment for Chlamydia trachomatis and Neisseria gonorrhoeae infections.

METHODOLOGY:

• Researchers conducted a quasi-experimental implementation study at the ED of Johns Hopkins Hospital involving 627 patients with suspected STIs (mean age, 31.7 years; 99.36% women) to examine the rates of appropriate treatment and ED length of stay.
• They compared two testing approaches for STIs caused by C trachomatis, N gonorrhoeae, and Trichomonas vaginalis: central laboratory nucleic acid amplification testing and/or wet mount preparation testing (n = 340; August-November 2022) and point-of-care PCR testing (n = 287; January-April 2023).
• Primary outcomes were the proportion of patients with a laboratory-confirmed STI receiving appropriate antibiotics during their ED stay and ED length of stay.
• Secondary outcomes included STI test result availability during visits and patient notification of positive results.
• Overtreatment was defined as antibiotics given to patients with negative STI test results and undertreatment as positive STI cases discharged without appropriate treatment.

TAKEAWAY:

• Among patients who were STI-negative, point-of-care testing vs central laboratory testing significantly reduced overtreatment rates for C trachomatis infection from 11.1% to 3.0% (P < .001) and for N gonorrhoeae infection from 10.6% to 4.0% (P = .002).
• No significant difference in antibiotic undertreatment was observed between testing approaches.
• Implementation of point-of-care testing decreased ED length of stay by an average of 9.3% (95% CI, 1.7%-16.3%; P = .017), equivalent to a 76-minute reduction.
• Compared with central laboratory testing, point-of-care testing demonstrated significantly greater availability of STI test results before ED discharge (2.9% vs 95.8%) and higher rates of patient notification for positive results during the ED visit (61.8% vs 95.5%; P < .001 for both).

IN PRACTICE:

“Use of a rapid (< 30-minute turnaround time) multiplex molecular POC [point-of-care] PCR could revolutionize ED management, leading to more precise, targeted treatment,” the authors wrote.

SOURCE:

This study was led by Gaby Dashler, MPH, and Kendall Maliszewski, both from Johns Hopkins University, Baltimore. It was published online on December 12, 2025, in Open Forum Infectious Diseases.

LIMITATIONS:

The single-center design in an urban academic ED may have limited generalizability. The point-of-care lab’s overnight closure (12 AM to 9 AM) may have led to an underestimation of the intervention’s effectiveness. Phases occurred in different seasons amid varying COVID rates, which may have introduced residual confounding.

DISCLOSURES:

This study was funded by Visby Medical. Several authors reported receiving research funding to their institutions from the funding company and the National Institute of Biomedical Imaging and Bioengineering. One author reported having paid consulting and speaking engagements at national conferences and an unpaid co-chair role for a professional society working group, and one author reported receiving consulting fees from private companies.

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