TOPLINE

Among pregnant individuals who later delivered at the same hospital, only 13.2% were tested for HIV infection, 4.7% for syphilis, and 22.9% for gonorrhea and chlamydia during their emergency department (ED) visit, despite presenting at an average of 9 weeks' gestation, highlighting missed opportunities to identify sexually transmitted infections (STIs) early and initiate prenatal care in a timely manner.

METHODOLOGY

• Researchers conducted a retrospective, single-center study of 470 pregnant individuals whose urine or serum pregnancy test results were positive and who presented to an urban, tertiary-care ED in Chicago between January and November 2018; 401 subsequently had live births within the same hospital system, and 69 had ectopic pregnancies.
• Data on demographic characteristics, gestational age, ED utilization, prenatal care, STI testing and diagnoses, and pregnancy outcomes were obtained from electronic medical records. 
• STI testing included tests for HIV infection, syphilis, gonorrhea and chlamydia, and trichomonas. Researchers also assessed whether patients had already received prenatal care or had a plan to access prenatal care at their first ED visit. 
• The study outcomes included STI testing and positivity during the ED visit and access to prenatal care. The association between having a prenatal care plan at the first ED visit and subsequent HIV or STI positivity was also assessed. 

TAKEAWAY

• Among 401 pregnant individuals who later had live births, only 13.2% were tested for HIV infection, 4.7% for syphilis, and 22.9% for gonorrhea and chlamydia during their ED visit.
• STI positivity during pregnancy was 8.2% for gonorrhea or chlamydia, 5.2% for trichomonas, 1.3% for syphilis, and 0.3% for HIV infection, even though testing during the ED visit was limited.
• Of the 33 patients who were diagnosed with gonorrhea or chlamydia during pregnancy, 54.5% had not been tested for these infections during their ED visit; 80% of the five patients diagnosed with syphilis had not been tested for syphilis during the ED visit.
• Among all pregnant individuals, only 23.6% had already attended a prenatal care appointment at their first ED visit, and 53.0% had some plan for prenatal care. Among pregnant individuals without a prenatal care plan, 67.2% received resources to arrange care; having a prenatal care plan was associated with lower odds of testing positive for HIV infection or any STI (odds ratio [OR], 0.46; P = .013) and gonorrhea or chlamydia (OR, 0.38; P = .016).

IN PRACTICE

"Policies for routine screening of pregnant persons for HIV and STIs in the ED could be easily implemented using the support of the EMR [electronic medical record] and could have a huge impact on early diagnosis and treatment and thus the prevention of downstream complications such as congenital syphilis," the authors wrote. 

"Linkage to care navigators and improved resources to access PNC [prenatal care] should ideally be provided in all EDs serving similar communities, " they added.

SOURCE

The study was led by Ngozi V. Pierce, University of Chicago, Pritzker School of Medicine, Chicago. It was published online on July 24, 2026, in The American Journal of Emergency Medicine.

LIMITATIONS

The study was limited by its single-center retrospective design and reliance on electronic medical record data. Incomplete documentation made it difficult to determine whether patients received all recommended prenatal STI screening and management, particularly when care occurred across multiple hospital systems. The timing of third-trimester HIV infection and syphilis testing was also unavailable, and some ectopic pregnancy encounters were incompletely documented, potentially resulting in missed STI diagnoses. Insurance status was assessed at chart review rather than at the ED visit and, therefore, may not have accurately reflected insurance status at the time of presentation.

DISCLOSURES

The research was not funded by any grants from the public, commercial, or not-for-profit sectors. 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.