Addressing Gender Disparities in Emergency Department STI Treatment

In emergency departments (EDs), clinicians often face challenging decisions when diagnosing and treating sexually transmitted infections (STIs) like chlamydia and gonorrhea. The prevalent practice has been to administer antibiotics empirically—treating patients immediately based on suspicion rather than waiting for lab results—leading to significant issues of overtreatment, particularly in men. A recent systematic review published in Academic Emergency Medicine revealed that nearly 38% of patients who tested negative for these infections still received antibiotics, highlighting unnecessary treatments that contribute to antimicrobial resistance, side effects, and increased healthcare costs.

Conversely, the review uncovered a troubling gender disparity: women are substantially undertreated for STIs in emergency settings. While men are more often overtreated, women frequently leave with untreated infections, increasing the risk of serious complications such as pelvic inflammatory disease, infertility, and chronic pelvic pain. Data from over 32,000 ED visits showed women are 3.5 times more likely than men to go untreated for confirmed cases, despite higher risks of adverse outcomes.

Several factors drive these disparities. Men, especially those who are gay or bisexual, tend to present with more evident symptoms and higher infection rates, prompting clinicians to treat promptly. Women, on the other hand, often undergo broader evaluations for abdominal and pelvic complaints, leading to lower pretest suspicion and deferred treatment. Biases in clinical assumptions and lower perceived risk further contribute to these gaps in care.

Innovations like rapid molecular testing—able to detect STIs within an hour—offer promising solutions by enabling real-time diagnostics and accurate treatment decisions. Shared decision-making, involving brief discussions about risks and benefits, can also help tailor care while reducing unnecessary antibiotic use. Moreover, follow-up calls for positive cases provide opportunities for interventions such as partner therapy and HIV prevention strategies.

To truly improve STI care in emergency settings, healthcare systems must prioritize measuring disparities, integrating decision support tools into electronic health records, and promoting equity-focused protocols. By doing so, EDs can deliver more balanced, evidence-based care that reduces harm and advances health for all genders.

This shift not only reduces unnecessary treatments but also addresses long-standing gender biases in medical care. Recognizing the patterns behind these disparities is essential for fostering a healthcare environment that prioritizes accuracy, fairness, and patient safety.

Source: https://medicalxpress.com/news/2025-06-hidden-problem-emergency-department-sti.html