BACKGROUND: Emergency departments (EDs) are key safety-net providers for sexually transmitted infections (STIs), yet diagnostic and treatment practices vary widely. Rising STI rates raise concerns about guideline adherence and disparities in antibiotic use.
METHODS: Data from the 2010–2022 National Hospital Ambulatory Medical Care Survey (NHAMCS) were used to identify selected urogenital STI-related ED visits among patients aged >/=15 years with pathogen-specific diagnoses (chlamydia, gonorrhea, or trichomoniasis) or nonspecific genitourinary symptom- or exposure-based diagnosis codes. Syphilis-related codes were not included because syphilis diagnosis, coding, and treatment pathways differ substantially from the same-visit empiric antibiotic decisions examined in this analysis. National trends were examined, and multivariable logistic regression was conducted to evaluate factors associated with pathogen-specific diagnosis and empiric antibiotic use.
RESULTS: Annual STI-related ED visits (pathogen-specific or nonspecific diagnoses) nearly doubled from an estimated 0.81 million to 1.56 million between 2010 and 2022 (92% increase). Among visits with pathogen-specific diagnoses (estimated 1.37 million), 91% occurred among female patients and 68% among Black patients. Empiric antibiotics were administered in 27% of all STI-related visits and 43% of visits with a pathogen-specific diagnosis. In adjusted models, Black patients had higher odds of a pathogen-specific diagnosis and antibiotic use than White patients. Male patients were less likely to receive a pathogen-specific diagnosis, but more likely to receive empiric antibiotics. Patients aged >/=35 years had lower odds of empiric treatment.
CONCLUSIONS: ED visits with STI-related diagnosis codes are rising nationally, with differences in diagnosis and empiric antibiotic use by sex and race. Findings suggest the need to address differences in STI treatment practices and expand use of rapid diagnostics in EDs.
Trends and disparities in selected urogenital STI-related emergency department visits, United States, 2010–2022
AJPM Focus [Epub 2026 Aug 14]. doi: 10.1016/j.focus.2026.100545.