Category: Infectious Disease
Keywords: STI, empiric treatment, sex disparity (PubMed Search)
Posted: 3/20/2026 by Lena Carleton, MD
(Updated: 3/23/2026)
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Bottom Line: Among adult ED patients tested for gonorrhea and chlamydia, empiric treatment often does not align with confirmed infection. There are also notable sex disparities; in this study, females with confirmed infection were ~3.5 times more likely than males to not receive empiric treatment.
Empiric treatment for gonorrhea (GC) and chlamydia trachomatis (CT) is common in the emergency department due to delayed test results. This systematic review and meta-analysis evaluated how well empiric treatment aligns with laboratory-confirmed infections, with a focus on overtreatment, undertreatment, and sex differences.
The authors included U.S.-based ED studies published between January 2010 and January 2025 (excluding pediatric EDs). Nineteen studies with 32,593 patients met the inclusion criteria. Although GC and CT were initially analyzed separately, they were combined due to inconsistent reporting.
Overall, 14% of tested patients had confirmed GC/CT (11% of females vs. 25% of males). Empiric treatment was given to 46% of patients, less often in females (31%) than in males (73%). Among patients with confirmed infection, 39% were not empirically treated, with a markedly higher rate in females (52%) compared to males (15%), suggesting females were ~3.5 times more likely to be undertreated.
Potential explanations include higher rates of symptomatic disease in males and broader testing in females with abdominal or pelvic complaints, which lowers test positivity rates. Bias, implicit or explicit, may also contribute.
Overall, there is significant discordance between empiric treatment and confirmed infection, with notable sex disparities. At the bedside, shared decision-making around empiric treatment is essential. At a systems level, EDs should ensure reliable follow-up processes to notify and treat patients who test positive after discharge.
Solnick RE, Patel R, Chang E, et al. Sex disparities in chlamydia and gonorrhea treatment in U.S. adult emergency departments: A systematic review and meta-analysis. Acad Emerg Med. 2025; 32: 1003-1016. doi:10.1111/acem.70070
