Sexually transmitted infections (STIs) are a common concern in emergency departments, where quick decisions must be made to provide timely treatment. However, a recent systematic review published in Academic Emergency Medicine sheds light on a hidden problem in STI care: the overtreating of men and the undertreating of women.
The review found that 38% of ED patients who ultimately tested negative for chlamydia or gonorrhea still received antibiotics. This high rate of unnecessary treatment can lead to antibiotic resistance, side effects, and unnecessary medical costs. Additionally, the review revealed a gender disparity in STI care, with women being undertreated for STIs far more often than men, who may receive antibiotics they do not need.
Chlamydia and gonorrhea are curable bacterial infections that can have serious consequences if left untreated, particularly for women. With STI clinics closing and limited access to primary care, emergency departments have become a critical setting for STI diagnosis and treatment. However, the review showed that treatment decisions in the ED are not always based on accurate diagnoses, leading to unnecessary antibiotic use and disparities in care.
One potential solution highlighted in the review is the use of rapid molecular tests that can detect chlamydia and gonorrhea in under an hour. These tests can provide real-time results, allowing for more informed treatment decisions. Shared decision-making with patients and ED callbacks for follow-up care are also recommended to improve STI care and reduce disparities.
By recognizing and tracking disparities, implementing better diagnostic tools, and focusing on equity in care, emergency departments can deliver faster, fairer, and evidence-based STI care. Ultimately, the goal is to reduce harm, improve outcomes, and provide high-quality care for all patients.
Rachel Solnick, MD, MSc, an Assistant Professor of Emergency Medicine at the Icahn School of Medicine at Mount Sinai, led the research and is dedicated to expanding access to high-quality reproductive and sexual health care for all emergency department patients. Her work focuses on HIV prevention, STI care, and maternal health, with a focus on improving outcomes and access to care for all patients.
In conclusion, the findings of this review highlight the importance of reevaluating treatment practices in emergency departments to ensure that all patients receive appropriate and timely care for STIs. By addressing the hidden problem of overtreating men and undertreating women, healthcare providers can work towards providing more equitable and effective STI care in emergency settings.
