{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"institution":[{"name":"medRxiv"}],"indexed":{"date-parts":[[2026,1,16]],"date-time":"2026-01-16T13:00:32Z","timestamp":1768568432370,"version":"3.49.0"},"posted":{"date-parts":[[2024,8,20]]},"group-title":"Emergency Medicine","reference-count":55,"publisher":"openRxiv","license":[{"start":{"date-parts":[[2024,8,20]],"date-time":"2024-08-20T00:00:00Z","timestamp":1724112000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/www.medrxiv.org\/about\/FAQ#license"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"accepted":{"date-parts":[[2024,8,20]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                <jats:sec>\n                  <jats:title>Importance<\/jats:title>\n                  <jats:p>In US emergency departments (EDs), empiric antibiotic treatment for gonorrhea (GC) and chlamydia (CT) is common due to the unavailability of immediate test results. Evidence suggests sex-based disparities in treatment practices, with females potentially receiving less empiric treatment than males.<\/jats:p>\n                <\/jats:sec>\n                <jats:sec>\n                  <jats:title>Objective<\/jats:title>\n                  <jats:p>To investigate sex differences in empiric antibiotic treatment for GC and CT in EDs, comparing practices to subsequent laboratory-confirmed results.<\/jats:p>\n                <\/jats:sec>\n                <jats:sec>\n                  <jats:title>Design, Setting, and Participants<\/jats:title>\n                  <jats:p>This systematic review and meta-analysis included studies from US EDs reporting GC\/CT testing and empiric antibiotic treatment from January 2010 to February 2021. A total of 1,644 articles were screened, with 17 studies (n = 31,062 patients) meeting inclusion criteria.<\/jats:p>\n                <\/jats:sec>\n                <jats:sec>\n                  <jats:title>Main Outcomes and Measures<\/jats:title>\n                  <jats:p>The primary outcomes were GC\/CT test positivity, empiric antibiotic treatment rates, and discordance between treatment and test results, stratified by sex. Data were analyzed using a random-effects model.<\/jats:p>\n                <\/jats:sec>\n                <jats:sec>\n                  <jats:title>Results<\/jats:title>\n                  <jats:p>Overall GC\/CT positivity was 14% (95% CI, 11%-16%): 11% (95% CI, 8%-14%) in females and 25% (95% CI, 23%-26%) in males. Empiric antibiotic treatment was administered in 46% (95% CI, 38%-55%) of cases: 31% (95% CI, 24%-37%) in females and 73% (95% CI, 65%-80%) in males. Among patients without a laboratory-confirmed infection, 38% (95% CI, 30%-47%) received treatment: 27% (95% CI, 20%-34%) of females and 64% (95% CI, 55%-73%) of males. Conversely, 39% (95% CI, 31%-48%) of patients with laboratory-confirmed infections were not treated: 52% (95% CI, 46%-57%) of females and 15% (95% CI, 12%-17%) of males.<\/jats:p>\n                <\/jats:sec>\n                <jats:sec>\n                  <jats:title>Conclusions and Relevance<\/jats:title>\n                  <jats:p>There is significant discordance between ED empiric antibiotic treatment and laboratory-confirmed results, with notable sex-based disparities. Females were 3.5 times more likely than males to miss treatment despite confirmed infection. These findings highlight the need for improved strategies to reduce sex-based disparities and enhance empiric treatment accuracy for GC\/CT in ED settings.<\/jats:p>\n                <\/jats:sec>\n                <jats:sec>\n                  <jats:title>Key Points<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Question<\/jats:title>\n                    <jats:p>Are there sex-based differences in empiric antibiotic treatment for gonorrhea and chlamydia in US emergency departments (EDs), and how do these practices compare to laboratory-confirmed results?<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Findings<\/jats:title>\n                    <jats:p>In this systematic review and meta-analysis of 17 studies with 31,062 patients, females were significantly less likely than males to receive empiric antibiotic treatment for gonorrhea and chlamydia. Additionally, 39% of patients with a laboratory-confirmed infection were not empirically treated, with females 3.5 times more likely to miss treatment than males.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Meaning<\/jats:title>\n                    <jats:p>The findings indicate significant sex disparities in ED empiric antibiotic treatment for sexually transmitted infections, underscoring the need for improved strategies to ensure equitable and accurate treatment across sexes.<\/jats:p>\n                  <\/jats:sec>\n                <\/jats:sec>","DOI":"10.1101\/2024.08.20.24312317","type":"posted-content","created":{"date-parts":[[2024,8,23]],"date-time":"2024-08-23T22:00:11Z","timestamp":1724450411000},"source":"Crossref","is-referenced-by-count":0,"title":["Sex Disparities in Chlamydia and Gonorrhea Treatment in US Adult Emergency Departments: A Systematic Review and Meta-analysis"],"prefix":"10.64898","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-2565-5690","authenticated-orcid":false,"given":"Rachel E","family":"Solnick","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Rahi","family":"Patel","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ethan","family":"Chang","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Carmen","family":"Vargas-Torres","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Maaz","family":"Munawar","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Carlin","family":"Pendell","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Judith E.","family":"Smith","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ethan","family":"Cowan","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Keith E","family":"Kocher","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Roland C","family":"Merchant","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"54368","reference":[{"key":"2024082319000658000_2024.08.20.24312317v1.1","unstructured":"National Overview of STIs, 2022. Published April 22, 2024. Accessed August 6, 2024. https:\/\/www.cdc.gov\/std\/statistics\/2022\/overview.htm"},{"key":"2024082319000658000_2024.08.20.24312317v1.2","doi-asserted-by":"publisher","DOI":"10.1007\/82_2016_15"},{"key":"2024082319000658000_2024.08.20.24312317v1.3","doi-asserted-by":"publisher","DOI":"10.1097\/OLQ.0000000000000894"},{"key":"2024082319000658000_2024.08.20.24312317v1.4","doi-asserted-by":"publisher","DOI":"10.1111\/acem.14511"},{"key":"2024082319000658000_2024.08.20.24312317v1.5","doi-asserted-by":"publisher","DOI":"10.1016\/j.ypmed.2017.04.028"},{"key":"2024082319000658000_2024.08.20.24312317v1.6","doi-asserted-by":"publisher","DOI":"10.1097\/OLQ.0000000000000928"},{"key":"2024082319000658000_2024.08.20.24312317v1.7","doi-asserted-by":"crossref","unstructured":"Workowski K , Bachmann L , Chan P et al. Sexually Transmitted Infections Treatment Guidelines, 2021. Morbidity and Mortality Weekly Report (MMWR) Recomm Rep 2021. Vol 70.; 2021. https:\/\/www.cdc.gov\/std\/treatment-guidelines\/STI-Guidelines-2021.pdf","DOI":"10.15585\/mmwr.rr7004a1"},{"key":"2024082319000658000_2024.08.20.24312317v1.8","unstructured":"First cases of gonorrhea resistant to several classes of antibiotics identified in the U.S. CNN. Published online January 19, 2023. Accessed February 27, 2023. https:\/\/www.cnn.com\/2023\/01\/19\/health\/first-us-multidrug-resistant-gonorrhea\/index.html"},{"key":"2024082319000658000_2024.08.20.24312317v1.9","unstructured":"Drug-Resistant Gonorrhea. Published March 2, 2023. Accessed May 1, 2023. https:\/\/www.cdc.gov\/std\/gonorrhea\/drug-resistant\/default.htm"},{"key":"2024082319000658000_2024.08.20.24312317v1.10","unstructured":"CDC. U.S. National Strategy for Combating Antibiotic-Resistant Bacteria (National Strategy). Centers for Disease Control and Prevention. Published April 1, 2021. Accessed May 1, 2023. https:\/\/www.cdc.gov\/drugresistance\/us-activities\/national-strategy.html"},{"key":"2024082319000658000_2024.08.20.24312317v1.11","doi-asserted-by":"publisher","DOI":"10.1016\/j.ajem.2019.05.054"},{"key":"2024082319000658000_2024.08.20.24312317v1.12","doi-asserted-by":"publisher","DOI":"10.1016\/j.jemermed.2012.08.022"},{"key":"2024082319000658000_2024.08.20.24312317v1.13","unstructured":"JBI, formerly known as the. Joanna Briggs Institute. Published June 10, 2021. Accessed February 28, 2023. https:\/\/joannabriggs.org\/"},{"key":"2024082319000658000_2024.08.20.24312317v1.14","doi-asserted-by":"publisher","DOI":"10.1186\/2049-3258-72-39"},{"key":"2024082319000658000_2024.08.20.24312317v1.15","unstructured":"Nyaga VN , Arbyn M , Aerts M. METAPROP_ONE: Stata module to perform fixed and random effects meta-analysis of proportions. Statistical Software Components. Published online January 26, 2017. Accessed August 7, 2024. https:\/\/ideas.repec.org\/c\/boc\/bocode\/s457861.html"},{"key":"2024082319000658000_2024.08.20.24312317v1.16","doi-asserted-by":"publisher","DOI":"10.1136\/sextrans-2012-050994"},{"key":"2024082319000658000_2024.08.20.24312317v1.17","doi-asserted-by":"publisher","DOI":"10.1097\/MOP.0000000000000578"},{"key":"2024082319000658000_2024.08.20.24312317v1.18","unstructured":"Reported STDs in the United States, 2021. Published August 4, 2023. Accessed August 8, 2023. https:\/\/www.cdc.gov\/nchhstp\/newsroom\/fact-sheets\/std\/std-us-2021.html"},{"key":"2024082319000658000_2024.08.20.24312317v1.19","unstructured":"National Overview of STDs, 2021. Published May 16, 2023. Accessed August 8, 2023. https:\/\/www.cdc.gov\/std\/statistics\/2021\/overview.htm"},{"key":"2024082319000658000_2024.08.20.24312317v1.20","unstructured":"Territo H , Ashurst JV. Nongonococcal Urethritis. StatPearls Publishing; 2022. Accessed July 23, 2023. https:\/\/www.ncbi.nlm.nih.gov\/books\/NBK535411\/"},{"key":"2024082319000658000_2024.08.20.24312317v1.21","doi-asserted-by":"publisher","DOI":"10.2105\/AJPH.80.11.1338"},{"key":"2024082319000658000_2024.08.20.24312317v1.22","doi-asserted-by":"publisher","DOI":"10.1016\/s0025-7125(16)30485-0"},{"key":"2024082319000658000_2024.08.20.24312317v1.23","doi-asserted-by":"publisher","DOI":"10.1186\/s12910-017-0179-8"},{"key":"2024082319000658000_2024.08.20.24312317v1.24","doi-asserted-by":"publisher","DOI":"10.1007\/s11606-013-2441-1"},{"key":"2024082319000658000_2024.08.20.24312317v1.25","doi-asserted-by":"publisher","DOI":"10.1111\/j.1553-2712.2008.00100.x"},{"issue":"5","key":"2024082319000658000_2024.08.20.24312317v1.26","first-page":"286","volume":"101","year":"2020","journal-title":"Sexual Health History: Techniques and Tips. afp"},{"key":"2024082319000658000_2024.08.20.24312317v1.27","doi-asserted-by":"publisher","DOI":"10.1097\/OLQ.0000000000001075"},{"key":"2024082319000658000_2024.08.20.24312317v1.28","doi-asserted-by":"publisher","DOI":"10.1016\/j.annemergmed.2017.03.063"},{"key":"2024082319000658000_2024.08.20.24312317v1.29","doi-asserted-by":"publisher","DOI":"10.1016\/j.ajem.2019.06.007"},{"key":"2024082319000658000_2024.08.20.24312317v1.30","doi-asserted-by":"publisher","DOI":"10.14423\/SMJ.0000000000000273"},{"key":"2024082319000658000_2024.08.20.24312317v1.31","doi-asserted-by":"publisher","DOI":"10.1097\/OLQ.0000000000000438"},{"key":"2024082319000658000_2024.08.20.24312317v1.32","doi-asserted-by":"publisher","DOI":"10.1016\/j.ajem.2012.11.017"},{"key":"2024082319000658000_2024.08.20.24312317v1.33","doi-asserted-by":"publisher","DOI":"10.1097\/OLQ.0000000000000299"},{"key":"2024082319000658000_2024.08.20.24312317v1.34","doi-asserted-by":"publisher","DOI":"10.1097\/pq9.0000000000000634"},{"key":"2024082319000658000_2024.08.20.24312317v1.35","unstructured":"Gaydos, Ako , Lewis, Hsieh . Use of a rapid diagnostic for Chlamydia trachomatis and Neisseria gonorrhoeae for women in the emergency department can improve clinical management \u2026. Ann Emerg Med. https:\/\/www.sciencedirect.com\/science\/article\/pii\/S019606441831271X?casa_token=Rcldc0pYoqMAAAAA:zC9MLZGBkgErIprGJMxKc6NWoya71JgpgWWUBWEtcR5B_maf1KezO_ZwvBrTVvnu9Qrpc6rRyLh"},{"key":"2024082319000658000_2024.08.20.24312317v1.36","doi-asserted-by":"publisher","DOI":"10.1016\/j.diagmicrobio.2016.10.019"},{"key":"2024082319000658000_2024.08.20.24312317v1.37","doi-asserted-by":"publisher","DOI":"10.1016\/j.emc.2024.02.006"},{"key":"2024082319000658000_2024.08.20.24312317v1.38","doi-asserted-by":"publisher","DOI":"10.1002\/14651858.CD002843.pub2"},{"key":"2024082319000658000_2024.08.20.24312317v1.39","doi-asserted-by":"publisher","DOI":"10.1101\/2023.04.01.23287999"},{"key":"2024082319000658000_2024.08.20.24312317v1.40","unstructured":"Legal Status of Expedited Partner Therapy. Published April 21, 2021. Accessed August 1, 2023. https:\/\/www.cdc.gov\/std\/ept\/legal\/"},{"key":"2024082319000658000_2024.08.20.24312317v1.41","unstructured":"Centers for Disease Control and Prevention. US Public Health Service: Preexposure Prophylaxis for the Prevention of HIV Infection in the United States \u2013 2021 Update Clinical Practice Guideline.; 2021. https:\/\/www.cdc.gov\/hiv\/pdf\/risk\/prep\/cdc-hiv-prep-guidelines-2021.pdf"},{"key":"2024082319000658000_2024.08.20.24312317v1.42","doi-asserted-by":"publisher","DOI":"10.1016\/j.emc.2024.02.007"},{"key":"2024082319000658000_2024.08.20.24312317v1.43","doi-asserted-by":"publisher","DOI":"10.1111\/acem.14718"},{"key":"2024082319000658000_2024.08.20.24312317v1.44","doi-asserted-by":"publisher","DOI":"10.1093\/cid\/ciu184"},{"key":"2024082319000658000_2024.08.20.24312317v1.45","doi-asserted-by":"publisher","DOI":"10.1056\/NEJM197401172900301"},{"key":"2024082319000658000_2024.08.20.24312317v1.46","unstructured":"Detailed STD Facts - Gonorrhea. Published April 10, 2023. Accessed August 10, 2023. https:\/\/www.cdc.gov\/std\/gonorrhea\/stdfact-gonorrhea-detailed.htm"},{"key":"2024082319000658000_2024.08.20.24312317v1.47","doi-asserted-by":"publisher","DOI":"10.5811\/westjem.2013.12.18989"},{"key":"2024082319000658000_2024.08.20.24312317v1.48","doi-asserted-by":"publisher","DOI":"10.1016\/j.ajem.2015.06.009"},{"key":"2024082319000658000_2024.08.20.24312317v1.49","doi-asserted-by":"publisher","DOI":"10.7759\/cureus.11244"},{"key":"2024082319000658000_2024.08.20.24312317v1.50","doi-asserted-by":"publisher","DOI":"10.1177\/0956462415604769"},{"key":"2024082319000658000_2024.08.20.24312317v1.51","doi-asserted-by":"publisher","DOI":"10.1016\/j.annemergmed.2018.09.012"},{"key":"2024082319000658000_2024.08.20.24312317v1.52","doi-asserted-by":"publisher","DOI":"10.1128\/JCM.00670-15"},{"key":"2024082319000658000_2024.08.20.24312317v1.53","doi-asserted-by":"publisher","DOI":"10.7759\/cureus.6482"},{"key":"2024082319000658000_2024.08.20.24312317v1.54","doi-asserted-by":"publisher","DOI":"10.1016\/j.ajem.2018.08.015"},{"key":"2024082319000658000_2024.08.20.24312317v1.55","doi-asserted-by":"publisher","DOI":"10.1177\/0956462419880379"}],"container-title":[],"original-title":[],"link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1101\/2024.08.20.24312317","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,1,15]],"date-time":"2026-01-15T20:09:49Z","timestamp":1768507789000},"score":1,"resource":{"primary":{"URL":"http:\/\/medrxiv.org\/lookup\/doi\/10.1101\/2024.08.20.24312317"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2024,8,20]]},"references-count":55,"URL":"https:\/\/doi.org\/10.1101\/2024.08.20.24312317","relation":{},"subject":[],"published":{"date-parts":[[2024,8,20]]},"subtype":"preprint"}}