Real-world Use of Molecular Point-of-care Testing for Sexually Transmitted Infections (STIs) in the Emergency Department: Why It Matters for Acute Care Management.

BACKGROUND

Point-of-care (POC) polymerase chain reaction (PCR) tests for sexually transmitted infections (STIs) represent a potential paradigm shift for emergency department (ED) management of patients with suspected STIs, given there are now Food and Drug Administration-cleared POC tests that permit definite rapid diagnosis and result-driven care.

METHODS

A quasi-experimental real-world implementation study was conducted in an urban ED, comparing two approaches for female STI testing for Chlamydia trachomatis (CT), Neisseria gonorrhoeae (NG), and Trichomonas vaginalis (TV): (1) central laboratory testing (August-November 2022) with batched nucleic acid amplification testing (CT/NG) and wet prep for TV; (2) POC PCR Testing Integration (ED POC) (January-April 2023) in an ED POC laboratory for all three STIs. We compared proportions of appropriate treatment and ED length of stay (LOS) between the two testing modalities using chi-square test and log-transformed multivariable linear regression, respectively.

RESULTS

Of 627 patients, 340 received central laboratory testing and 287 received ED POC; ED POC resulted in a significant decrease in LOS by 76 minutes or 9.3% (95% confidence interval [CI], -16.3% to -1.7%; P = .017). ED POC also significantly lowered overtreatment rates for CT (n = 595) and NG (n = 607) by 73% (95% CI, 44-87; P < .001) and 63% (95% CI, 28-81; P = .002), respectively. ED POC testing was associated with 67% lower rate of undertreatment (95% CI, -19% to 91%; P = .093) for any CT/NG/TV-positive (n = 78), but not statistically significant due to relatively small number of undertreated cases .

DISCUSSION: Compared to traditional STI testing, POC PCR testing significantly shortened ED LOS, allowed for organism-specific targeted treatment, and reduced overtreatment of CT and NG infections.