Why Most People With STI Symptoms Aren't Getting Tested in Emergency Rooms

Despite presenting with symptoms suggestive of sexually transmitted infections (STIs), only 37.8% of patients receive testing in emergency departments across the United States. This alarming gap in care affects millions of Americans seeking help for sexual health concerns, according to a comprehensive study analyzing over 5.5 million emergency room visits.

What Does the Testing Gap Look Like in Numbers?

Researchers from Rush University Medical Center examined 5,566,966 emergency department encounters from 2016 through 2024, focusing on patients aged 15 and older who came to the emergency room with complaints suggesting possible STIs. The study population was diverse, with 61.5% being women, 54.7% White individuals, and notably, 37.5% were aged 40 or older.

The testing patterns revealed significant disparities in care. While gonorrhea and chlamydia testing occurred in 34.1% of encounters, other critical infections received far less attention. Testing rates dropped dramatically for other conditions, with bacterial vaginosis and trichomonas testing at 21.7% of visits.

Which STIs Are Being Overlooked Most?

The study uncovered particularly concerning gaps in testing for some of the most serious sexually transmitted infections:

• HIV Testing: Only 4.1% of patients with STI symptoms received HIV testing, despite the critical importance of early detection for treatment and prevention
• Syphilis Screening: Just 3.9% of symptomatic patients were tested for syphilis, even though rates of this infection have been rising nationally
• Comprehensive Co-testing: Among patients who did receive gonorrhea and chlamydia testing, only 9.3% also got syphilis testing and 8.5% received HIV testing

Even more troubling, the limited co-testing means that patients might receive treatment for one infection while unknowingly carrying others. Among those tested for gonorrhea and chlamydia, 56.0% were also tested for bacterial vaginosis or trichomonas, but the majority missed screening for HIV and syphilis.

How Are Emergency Departments Handling Treatment?

The study also examined treatment patterns, revealing inconsistent approaches to care. Among patients tested for gonorrhea and chlamydia, 46.2% received immediate antibiotic treatment in the emergency department. Interestingly, these rates peaked at 53.2% in 2020 before declining to 40.6% by 2024, suggesting changing practices over time.

For patients tested for bacterial vaginosis or trichomonas, treatment approaches varied significantly. Only 13.4% received immediate treatment in the emergency department, while 32.4% were given prescriptions for outpatient treatment.

"These findings underscore the need for standardized approaches to ED-based STI care that prioritize comprehensive testing, appropriate empiric treatment, and alignment with public health goals," the study authors wrote. They emphasized that emergency departments serve as a critical access point for STI diagnosis and management, particularly for patients who may not have regular healthcare providers.

The research team, led by Dr. Michael Gottlieb from Rush University Medical Center, noted that targeted interventions to strengthen testing and treatment practices in emergency departments could significantly improve patient outcomes and reduce transmission rates in the broader population.

This testing gap represents a missed opportunity for early intervention and prevention, particularly concerning given that emergency departments often serve as safety nets for patients without regular access to sexual health services. The findings suggest that many people seeking help for potential STIs may leave the emergency room without knowing their true health status, potentially continuing to spread infections unknowingly.