Interventions to Improve Care for Bacterial Sexually Transmitted Infections in Emergency Departments: A Narrative Review.

Abstract

Bacterial sexually transmitted infections (STIs) remain a major public health challenge in the United States, and emergency departments are important sites for diagnosis and treatment among patients with limited access to routine sexual health care. This narrative review summarizes United States studies of emergency department interventions to improve testing, diagnosis, treatment, and follow-up for chlamydia, gonorrhea, and syphilis. We searched PubMed for English-language studies published from 1990 through 2025 that evaluated bacterial sexually transmitted infection interventions in emergency department settings. Twenty-two studies met inclusion criteria. Universal screening produced large increases in testing and case detection, electronic record prompts improved screening uptake, point-of-care testing improved same-day diagnosis and treatment while reducing unnecessary antibiotic use, and patient-directed tools produced modest gains. Bundled interventions addressing multiple steps in the care pathway appeared to have the largest overall impact, though there was heterogeneity in the interventions included making direct comparisons difficult. Future studies should further evaluate implementation feasibility, sustainability, equity, and cost-effectiveness of STI interventions across diverse emergency department settings.