(O-E4) Prevalence of Emergency Department-based Treatment for Sexually Transmitted Infections by Test Results and Gender: Systematic Review and Meta-analysis

Objective: In US emergency departments (EDs), antibiotic treatment for gonorrhea (GC) and chlamydia (CT) typically is empiric because test results usually are not available during the ED visit. Because males more often than females have and report symptoms from and show signs of an infection from GC or CT, females might be less likely than males to receive GC and CT empiric antibiotic treatment in the ED. In this investigation, we investigated gender differences in ED empiric antibiotic treatment of GC and CT as compared to subsequent laboratory-confirmed test results for these infections.

Methods: We conducted a systematic review and meta-analysis of US ED studies that reported GC and CT testing and empiric antibiotic treatment. We searched seven databases (Medline, Cochrane, Embrace, Scopus, Web of Science, CINAHL, and PsychInfo) for relevant studies from 1/2010 to 2/2021. Study selection, quality assessment, and data extraction were performed by two reviewers, and disagreement was resolved by a third. JBI Research Institute critical appraisal tools were used to assess study quality. The principal data point extracted was empiric testing proportions by gender according to laboratory-confirmed test results. For studies did not provide gender-specific results, data were classified in a “combined sex” category. We conducted a random-effects meta-analysis to calculate pooled estimates of GC/CT empiric treatment. The study was pre-registered (Prospero #241429), followed PRISMA reporting guidelines, and used STATA 16.0 for meta-analytic calculations.

Results: Of 1644 deduplicated articles considered, 16 met inclusion criteria, and represented 33,734 ED patients, primarily from the Midwestern US. Across these 16 studies, GC/CT test positivity was 13% (95%CI, 11%-16%); 11% (95%CI, 8%-14%) for females, and 23% (95%CI, 17%-30%) for males. GC/CT ED empiric antibiotic treatment among those tested was 44% (95%CI, 33%-55%); 33% (95%CI, 23%-42%) for females, 71% (95%CI, 68%-74%) for males. Among those without a laboratory-confirmed GC/CT infection, ED empiric treatment was 44% (95%CI, 33%-54%); 35% (95%CI, 25%-45%) for females, 64% (95%CI, 55%-73%) for males. Among those with a laboratory-confirmed GC/CT infection, no empiric antibiotic treatment was provided for 40% (95%CI, 30%-50%); 52% (95%CI, 46%-59%) for females, 13% (95%CI, 10%-16%) for males.

Conclusion: ED empiric antibiotic treatment for GC/CT is often discrepant with final laboratory test results. Females were two-fold less likely than males to receive ED empiric antibiotic treatment. Among those with a laboratory-confirmed infection, females were four-fold more likely than males to have not been provided ED empiric antibiotics. These results indicate gender disparities in GC/CT ED empiric antibiotic treatment and the critical need for accurate rapid GC/CT point-of-care testing.