Comment on “Sexually Transmitted Infection Treatment Rates Among Pregnant Versus Nonpregnant Patients in Emergency Departments”

Abstract

Sexually transmitted infections (STIs), particularly Neisseria gonorrhoeae and Chlamydia trachomatis , remain a significant public health concern in the United States and are associated with adverse maternal and neonatal outcomes during pregnancy. For patients who face structural barriers to care, such as insurance status, housing instability, and limited access to primary care, emergency departments (EDs) frequently become the point of health care access and provide STI evaluation and treatment. The Centers for Disease Control and Prevention (CDC) guidelines recommend empiric treatment when clinical concern is high or follow-up is uncertain. Yet, it is unclear whether treatment practices differ for pregnant patients or across demographic groups. The aim of this study was to compare rates of empiric STI treatment in EDs according to pregnancy status and patient characteristics. This was a repeated cross-sectional study, using aggregated, deidentified data from the Epic Cosmos electronic health record database. Included were patients, 15 years or older, who visited an ED between January 2016 and December 2024 and were tested for N. gonorrhoeae or C. trachomatis . The primary outcome was empiric treatment with antibiotics during the same ED encounter in which testing was performed. Treatment rates were compared between pregnant and nonpregnant patients and by age, race, ethnicity, primary language, and insurance source. Of the 4,904,343 ED encounters involving STI testing identified for analysis, 9.3% involved pregnant patients. Empiric treatment was administered to 10.9% of pregnant patients versus 38.2% of nonpregnant patients [odds ratio (OR), 0.20; 95% CI, 0.20-0.20]. In comparing just female patients, pregnant patients were significantly less likely to receive empiric treatment compared with nonpregnant patients (OR, 0.27; 95% CI, 0.27-0.28). Among pregnant patients, empiric treatment was more likely to occur in adolescents aged 15 to 17 years versus those aged 18 to 29 (OR, 1.43; 95% CI, 1.36-1.49) and Black patients versus White patients (OR, 1.58; 95% CI, 1.55-1.61). Empiric treatment was less likely to occur among pregnant patients who were Asian (OR, 0.67; 95% CI, 0.62-0.72), Hispanic or Latino (OR, 0.78; 95% CI, 0.76-0.80), and whose primary language was not English (OR, 0.76; 95% CI, 0.73-0.79). Empiric treatment was more common in those with Medicaid (OR, 1.17; 95% CI, 1.15-1.19), Medicare (OR, 1.37; 95% CI, 1.25-1.49), or self-pay insurance (OR, 1.30; 95% CI, 1.26-1.35), compared with patients with commercial insurance. For nonpregnant patients, empiric treatment was less common among patients aged 18 to 29 years versus those younger than 15 (OR, 0.84; 95% CI, 0.83-0.85) or 50 years or older (OR, 0.78; 95% CI, 0.78-0.79), and male versus female patients (OR, 0.38; 95% CI, 0.37-0.39). Compared with White patients, empiric treatment was more likely to occur among patients who were Black (OR, 1.57; 95% CI, 1.55-1.58), American Indian or Alaska Native patients (OR, 1.11; 95% CI, 1.07-1.15), and Native Hawaiian or Other Pacific Islander (OR, 1.15; 95% CI, 1.10-1.21). Asian patients (OR, 0.72; 95% CI, 0.69-0.75), Hispanic or Latino patients (OR, 0.72; 95% CI, 0.72-0.73), and those whose primary language was Spanish (OR, 0.64; 95% CI, 0.63-0.66) were less likely to receive empiric treatment. Treatment rates were highest among those with self-pay insurance (OR, 1.91; 95% CI, 1.89-1.93), followed by those with Medicaid (OR, 1.08; 95% CI, 1.07-1.09). In conclusion, pregnant patients who went to the ED for N. gonorrhoeae or C. trachomatis were less likely to receive empiric STI treatment than nonpregnant patients. Treatment rates also varied by demographic characteristics, including age, race, ethnicity, primary language, and insurance source. (Summarized from Gottlieb M, Moyer E, Slocum GW, et al. Sexually transmitted infection treatment rates among pregnant vs. nonpregnant patients in emergency departments. JAMA Network Open . 2026;9(4):e264911. doi:10.1001/jamanetworkopen.2026.4911).