Emergency department sexually transmitted disease and human immunodeficiency virus screening: findings from a national survey.

OBJECTIVES To use a previously conducted national physician survey to determine the extent of human immunodeficiency virus (HIV) and sexually transmitted disease (STD) screening by emergency physicians compared with physicians practicing in other settings (primary care offices, hospital ambulatory care clinics, or other). METHODS From the survey responses, the authors determined the percentage of emergency physicians and physicians not practicing in EDs screening various patient groups for syphilis, gonorrhea, chlamydia, and HIV. Additional data from the survey (for practice location, physician gender, and patient demographics of race and gender) were used in multivariate logistic regressions to determine adjusted odds ratios (ORs). RESULTS Of 3,838 survey respondents providing answers to all questions analyzed for this study, 401 (10.5%) practiced in an emergency department. Of the remaining 3,437 physicians, 89% practiced in primary care offices or hospital ambulatory care clinics. Based on unadjusted ORs, emergency physicians were less likely than physicians not practicing in EDs to screen for all STDs and HIV in all patient groups (men, nonpregnant women, and pregnant women), although the differences in screening rates in male patients for chlamydia or gonorrhea were not significant. The adjusted ORs varied from 0.136 (for HIV screening of pregnant women) to 1.177 (for gonorrhea screening of pregnant women). All adjusted ORs that were significant at p < 0.05 were < 1.0. CONCLUSIONS Although prior research has shown that STD and HIV rates are relatively high in emergency department patients compared with the population as a whole, screening rates are lower than in other settings. Addressing barriers may increase screening rates.