The American journal of emergency medicine · 2026
Diagnosis and treatment of sexually transmitted infections among emergency department patients.
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Gottlieb Michael, Moyer Eric, Buell Kevin G, Fleegler Melissa, Mehta Supriya, Popovich Kyle J, Rothman Richard E, Hsieh Yu-Hsiang, Bernard Kyle, Haukoos Jason
Аннотация
INTRODUCTION: Sexually transmitted infections (STIs) remain a major public health concern, with emergency departments (EDs) serving as key sites for evaluation and treatment. Despite their importance, contemporary national-level data describing ED testing and treatment practices for patients presenting with symptoms suggestive of STI are limited.
METHODS: We performed a retrospective cohort study of ED encounters from 2016 to 2024 using Cosmos, a large geographically diverse electronic health record database. Patients aged ≥15 years with symptoms suggestive of an STI were included. We examined diagnostic testing for Neisseria gonorrhoeae/Chlamydia trachomatis (NG/CT), Trichomonas vaginalis/bacterial vaginosis (TV/BV), syphilis, and HIV. Pregnancy testing was assessed among females aged 15-55 years. Empiric antibiotic treatment patterns were evaluated over time.
RESULTS: Among 5,566,966 unique ED encounters, only 37.8 % underwent STI testing. NG/CT was the most frequently ordered test (34.1 %), followed by TV/BV (21.7 %), HIV (4.1 %), and syphilis (3.9 %). Among those tested for NG/CT, co-testing was 56.0 % for TV/BV, 9.3 % for syphilis, and 8.5 % for HIV. Pregnancy testing occurred in 68.5 % of eligible females. Nearly half (46.2 %) of NG/CT-tested patients received empiric treatment. Among TV/BV-tested patients, 13.4 % were empirically treated in the ED and 32.4 % were prescribed outpatient treatment.
CONCLUSION: Most ED patients who presented for conditions suggestive of STI did not undergo STI testing, and co-testing for other STIs was also uncommon. Empiric antibiotic therapy remains very common, occurring in approximately half of patients. These findings highlight opportunities to improve STI detection and treatment in EDs through standardized protocols and expanded use of co-testing.
METHODS: We performed a retrospective cohort study of ED encounters from 2016 to 2024 using Cosmos, a large geographically diverse electronic health record database. Patients aged ≥15 years with symptoms suggestive of an STI were included. We examined diagnostic testing for Neisseria gonorrhoeae/Chlamydia trachomatis (NG/CT), Trichomonas vaginalis/bacterial vaginosis (TV/BV), syphilis, and HIV. Pregnancy testing was assessed among females aged 15-55 years. Empiric antibiotic treatment patterns were evaluated over time.
RESULTS: Among 5,566,966 unique ED encounters, only 37.8 % underwent STI testing. NG/CT was the most frequently ordered test (34.1 %), followed by TV/BV (21.7 %), HIV (4.1 %), and syphilis (3.9 %). Among those tested for NG/CT, co-testing was 56.0 % for TV/BV, 9.3 % for syphilis, and 8.5 % for HIV. Pregnancy testing occurred in 68.5 % of eligible females. Nearly half (46.2 %) of NG/CT-tested patients received empiric treatment. Among TV/BV-tested patients, 13.4 % were empirically treated in the ED and 32.4 % were prescribed outpatient treatment.
CONCLUSION: Most ED patients who presented for conditions suggestive of STI did not undergo STI testing, and co-testing for other STIs was also uncommon. Empiric antibiotic therapy remains very common, occurring in approximately half of patients. These findings highlight opportunities to improve STI detection and treatment in EDs through standardized protocols and expanded use of co-testing.