Sexually Transmitted Infection Treatment Rates Among Pregnant vs Nonpregnant Patients in Emergency Departments

Area of Science:

• Public Health
• Infectious Diseases
• Health Services Research

Background:

• Emergency departments (EDs) are vital for diagnosing and treating sexually transmitted infections (STIs), especially for those with limited outpatient access.
• National guidelines advocate for empiric treatment of Neisseria gonorrhea and Chlamydia trachomatis in EDs when follow-up is uncertain.
• Limited data exist on empiric treatment patterns across different patient demographics and pregnancy statuses within EDs.

Purpose of the Study:

• To compare empiric treatment rates for Neisseria gonorrhea and Chlamydia trachomatis between pregnant and nonpregnant patients in EDs.
• To investigate demographic variations in empiric STI treatment within pregnant and nonpregnant patient groups.

Main Methods:

• A repeated cross-sectional study analyzed deidentified electronic health record data from the Epic Cosmos database (January 2016-December 2024).
• The study included ED encounters for patients tested for Neisseria gonorrhea or Chlamydia trachomatis.
• Empiric treatment was defined as guideline-recommended antibiotic administration during the same ED encounter as testing. Associations were analyzed using unadjusted odds ratios.

Main Results:

• Out of nearly 5 million encounters, 10.9% of pregnant patients and 38.2% of nonpregnant patients received empiric treatment.
• Pregnant patients had significantly lower odds of receiving empiric treatment compared to nonpregnant patients (OR, 0.20).
• Empiric treatment was more common in younger patients, those with noncommercial insurance, and English speakers, with variations observed across racial and ethnic groups.

Conclusions:

• Significant disparities in empiric STI treatment exist between pregnant and nonpregnant patients in US EDs.
• These differences may stem from varied guideline interpretation, communication challenges, and structural barriers to care, rather than solely clinician bias.
• Further understanding of these disparities is crucial for developing equitable STI management strategies in emergency care settings.