Sex disparities in chlamydia and gonorrhea treatment in U.S. adult emergency departments: A systematic review and meta-analysis.

IF 3.4 3区医学 Q1 EMERGENCY MEDICINE

Academic Emergency Medicine Pub Date : 2025-06-12 DOI:10.1111/acem.70070

Rachel E Solnick, Rahi Patel, Ethan Chang, Carmen Vargas-Torres, Maaz Munawar, Carlin Pendell, Judith E Smith, Ethan Cowan, Keith E Kocher, Roland C Merchant

{"title":"Sex disparities in chlamydia and gonorrhea treatment in U.S. adult emergency departments: A systematic review and meta-analysis.","authors":"Rachel E Solnick, Rahi Patel, Ethan Chang, Carmen Vargas-Torres, Maaz Munawar, Carlin Pendell, Judith E Smith, Ethan Cowan, Keith E Kocher, Roland C Merchant","doi":"10.1111/acem.70070","DOIUrl":null,"url":null,"abstract":"Background: Empiric antibiotic treatment for gonorrhea (GC) and chlamydia (CT) is common in U.S. emergency departments (EDs) due to the delayed availability of test results. Local studies have identified sex-based disparities in sexually transmitted infection (STI) care, with females potentially receiving less empiric treatment than males. This study evaluates how STI treatment aligns with laboratory-confirmed results to quantify potential overtreatment and undertreatment rates and investigates sex differences for these outcomes.Methods: We conducted a preregistered (PROSPERO #241429) systematic review and meta-analysis of studies published between January 2010 and January 2025 in U.S. EDs, excluding studies conducted exclusively in pediatric settings. Searches were performed in Medline, Cochrane, Embase, Scopus, Web of Science, CINAHL, and PsycINFO. Data from 19 studies encompassing 32,593 tested patients were analyzed using a random-effects model to calculate pooled estimates. Primary outcomes included GC/CT positivity, empiric treatment rates, and discordance between treatment and test results stratified by sex.Results: Overall GC/CT positivity was 14% (95% confidence interval [CI] 12%-16%): 11% (95% CI 8%-14%) in females and 25% (95% CI 23%-26%) in males. Antibiotics were given to 46% (95% CI 38%-54%) of patients: 31% (95% CI 24%-37%) of females and 73% (95% CI 65%-80%) of males. Among patients with negative test results, 38% (95% CI 30%-47%) received antibiotics (i.e., potential overtreatment): 27% (95% CI 20%-34%) of females and 64% (95% CI 55%-73%) of males. Conversely, 39% (95% CI 31%-46%) of laboratory-positive patients did not receive antibiotics (i.e., potential undertreatment): 52% (95% CI 46%-57%) of females and 15% (95% CI 12%-17%) of males.Conclusions: Significant sex-based disparities exist in ED empiric antibiotic treatment for GC/CT. Females were 3.5 times more likely than males to be potentially undertreated. These findings underscore the need for targeted interventions to reduce disparities and improve treatment accuracy. Interpretation is limited by study heterogeneity and incomplete sex-specific data.","PeriodicalId":7105,"journal":{"name":"Academic Emergency Medicine","volume":" ","pages":""},"PeriodicalIF":3.4000,"publicationDate":"2025-06-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Academic Emergency Medicine","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1111/acem.70070","RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q1","JCRName":"EMERGENCY MEDICINE","Score":null,"Total":0}

引用次数: 0

Abstract

Background: Empiric antibiotic treatment for gonorrhea (GC) and chlamydia (CT) is common in U.S. emergency departments (EDs) due to the delayed availability of test results. Local studies have identified sex-based disparities in sexually transmitted infection (STI) care, with females potentially receiving less empiric treatment than males. This study evaluates how STI treatment aligns with laboratory-confirmed results to quantify potential overtreatment and undertreatment rates and investigates sex differences for these outcomes.

Methods: We conducted a preregistered (PROSPERO #241429) systematic review and meta-analysis of studies published between January 2010 and January 2025 in U.S. EDs, excluding studies conducted exclusively in pediatric settings. Searches were performed in Medline, Cochrane, Embase, Scopus, Web of Science, CINAHL, and PsycINFO. Data from 19 studies encompassing 32,593 tested patients were analyzed using a random-effects model to calculate pooled estimates. Primary outcomes included GC/CT positivity, empiric treatment rates, and discordance between treatment and test results stratified by sex.

Results: Overall GC/CT positivity was 14% (95% confidence interval [CI] 12%-16%): 11% (95% CI 8%-14%) in females and 25% (95% CI 23%-26%) in males. Antibiotics were given to 46% (95% CI 38%-54%) of patients: 31% (95% CI 24%-37%) of females and 73% (95% CI 65%-80%) of males. Among patients with negative test results, 38% (95% CI 30%-47%) received antibiotics (i.e., potential overtreatment): 27% (95% CI 20%-34%) of females and 64% (95% CI 55%-73%) of males. Conversely, 39% (95% CI 31%-46%) of laboratory-positive patients did not receive antibiotics (i.e., potential undertreatment): 52% (95% CI 46%-57%) of females and 15% (95% CI 12%-17%) of males.

Conclusions: Significant sex-based disparities exist in ED empiric antibiotic treatment for GC/CT. Females were 3.5 times more likely than males to be potentially undertreated. These findings underscore the need for targeted interventions to reduce disparities and improve treatment accuracy. Interpretation is limited by study heterogeneity and incomplete sex-specific data.

查看原文本刊更多论文

美国成人急诊科衣原体和淋病治疗的性别差异：系统回顾和荟萃分析。

背景：淋病（GC）和衣原体（CT）的经验性抗生素治疗在美国急诊科（EDs）很常见，因为检测结果的可用性延迟。当地的研究已经确定了性传播感染（STI）护理方面的性别差异，女性接受的经验性治疗可能少于男性。本研究评估了性传播感染治疗如何与实验室证实的结果相一致，以量化潜在的过度治疗和治疗不足率，并调查了这些结果的性别差异。方法：我们对2010年1月至2025年1月期间在美国ed发表的研究进行了预注册（PROSPERO #241429）系统评价和荟萃分析，不包括专门在儿科进行的研究。在Medline、Cochrane、Embase、Scopus、Web of Science、CINAHL和PsycINFO中进行了搜索。来自19项研究的数据包括32,593名接受测试的患者，使用随机效应模型来计算汇总估计。主要结局包括GC/CT阳性、经验治疗率以及按性别分层的治疗和试验结果之间的不一致。结果：总体GC/CT阳性为14%(95%可信区间[CI] 12%-16%)，女性为11% (95% CI 8%-14%)，男性为25% （95% CI 23%-26%）。46% （95% CI 38%-54%）的患者接受了抗生素治疗，女性为31% (95% CI 24%-37%)，男性为73% （95% CI 65%-80%）。在检测结果阴性的患者中，38% （95% CI 30%-47%）接受了抗生素治疗（即潜在的过度治疗）：27% （95% CI 20%-34%）的女性和64% （95% CI 55%-73%）的男性。相反，39% （95% CI 31%-46%）的实验室阳性患者未接受抗生素治疗（即可能治疗不足）：52% （95% CI 46%-57%）的女性和15% （95% CI 12%-17%）的男性。结论：GC/CT的ED经验性抗生素治疗存在显著的性别差异。女性潜在治疗不足的可能性是男性的3.5倍。这些发现强调了采取有针对性的干预措施以减少差异和提高治疗准确性的必要性。研究异质性和不完整的性别特异性数据限制了解释。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

求助全文

约1分钟内获得全文求助全文

来源期刊

Academic Emergency Medicine 医学-急救医学

CiteScore

7.60

自引率

6.80%

发文量

207

审稿时长

3-8 weeks

期刊介绍： Academic Emergency Medicine (AEM) is the official monthly publication of the Society for Academic Emergency Medicine (SAEM) and publishes information relevant to the practice, educational advancements, and investigation of emergency medicine. It is the second-largest peer-reviewed scientific journal in the specialty of emergency medicine. The goal of AEM is to advance the science, education, and clinical practice of emergency medicine, to serve as a voice for the academic emergency medicine community, and to promote SAEM''s goals and objectives. Members and non-members worldwide depend on this journal for translational medicine relevant to emergency medicine, as well as for clinical news, case studies and more. Each issue contains information relevant to the research, educational advancements, and practice in emergency medicine. Subject matter is diverse, including preclinical studies, clinical topics, health policy, and educational methods. The research of SAEM members contributes significantly to the scientific content and development of the journal.