Sexually transmitted infections screening in the emergency department is feasible, but is it efficient ?

Emergency departments (EDs) are playing an increasingly important role in screening for HIV, viral hepatitis, and sexually transmitted infections (STIs), particularly among populations with limited access to routine care. This review examines recent evidence on ED-based screening strategies and evaluates their effectiveness, operational impact, and relevance to acute and critical care settings.

Recent pragmatic trials, implementation studies, and large observational analyses have demonstrated that screening outcomes in EDs depend strongly on the screening strategy selected, the infections targeted, and the capacity of downstream care. Targeted opt-in approaches consistently miss infections and rarely increase new diagnoses, even when supported by electronic decision tools. Nontargeted opt-out strategies identify more infections but are associated with higher costs and substantial attrition along the care cascade. In contrast, opt-out syphilis screening has shown marked increases in case detection, particularly among asymptomatic individuals, highlighting important infection-specific differences in screening value.

ED-based STI screening is not uniformly beneficial. Its clinical and public health impact depends on selective implementation, infection epidemiology, and robust linkage-to-care systems. Screening strategies aligned with these principles can extend the role of EDs beyond acute care, without compromising their core mission.