Longitudinal Analysis of Sexually Transmitted Infection and Human Immunodeficiency Virus Prevention Outcomes Among Emergency Department Patients Seeking Sexual Health-Related Care: A Retrospective Cohort Study.

BACKGROUND

Sexually transmitted infections (STIs) continue to increase in the United States, disproportionately affecting young adults, racial/ethnic minorities, and individuals with limited access to primary care. Emergency departments (EDs) represent a critical but underutilized setting for integrating STI management with HIV prevention efforts, including pre-exposure prophylaxis (PrEP).

METHODS

We conducted a retrospective cohort study of adult patients presenting with sexual health-related encounters to 3 EDs in the Bronx, NY (2021-2022). Encounters were identified using International Classification of Disease-10 codes linked to STI testing. We assessed factors associated with STI diagnosis and evaluated HIV prevention outcomes over 12 months among those with a confirmed STI. Associations were reported using prevalence ratios (PRs) and multivariable logistic regression.

RESULTS

Among 330,124 ED encounters, 8035 patients met criteria for sexual health-related care; 7% (n = 547) had a new STI diagnosis. STI prevalence was higher among cisgender men (PR = 2.60, 95% confidence interval [CI]: 2.21-3.05), Black patients (PR = 1.68, 95% CI: 1.42-1.98), patients aged 18-29 (PR = 2.26, 95% CI: 1.86-2.76), those with prior STIs (PR = 3.26, 95% CI: 2.56-4.14), and those with a substance use diagnosis (PR =1.90, 95% CI: 1.48-2.42). Within 12 months, 28% were retested for HIV, 36% for STIs, 10% discussed PrEP, 1% initiated PrEP, and 1 patient seroconverted.

CONCLUSIONS

EDs are critical access points for STI detection among high-risk groups; however, HIV prevention uptake remains suboptimal. Strengthening linkage to longitudinal care is urgently needed.