HIV screening in patients diagnosed with sexually transmitted infections in Spanish emergency departments

To estimate the frequency of HIV serology requests in emergency departments (EDs) in Spain for patients with sexually transmitted infections (STIs), its longitudinal evolution (2018-2024), and associated factors.

Multi-center study including all patients diagnosed with an STI across 14 EDs in 8 Spanish autonomous communities. Demographics, specific STI diagnoses, prior HIV testing, and HIV serology requested during ED care were recorded. Differences and temporal trends were analyzed.

Among 35,845 STI cases (median age 34 years; 60% men; 74% Spanish; 2% previously tested for HIV), HIV serology was requested in 5,462 (15%), yielding 253 (4.6%) positive results. Main diagnoses included orchiepididymitis (24.9%), vulvovaginitis (16.4%), and non-specific urethritis (12.4%). HIV testing increased significantly from 5.3% in 2018 to 20.7% in 2024 (p < 0.001). Higher testing likelihood was associated with younger age (aOR 0.97 per year, 95% CI 0.97-0.97), male sex (aOR 3.83, 95% CI 3.35-4.37), prior HIV testing (aOR 1.44, 95% CI 1.08-1.92), and more recent years (aOR 1.34 per year, 95% CI 1.30-1.38). Testing rates varied significantly by specific STI, with higher probabilities in risk exposure, suspected STI, and urethritis but lower probabilities in orchiepididymitis, vulvovaginitis, and genital herpes.

HIV screening among patients presenting with STIs in Spanish EDs remains low (15%), despite a significant upward trend over time. Disparities based on age, sex, and specific STI presentation highlight the need for universal HIV screening protocols across all ED patients diagnosed with an STI.