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Local studies have identified sex\u2010based 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\u2010confirmed results to quantify potential overtreatment and undertreatment rates and investigates sex differences for these outcomes.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>We conducted a preregistered (PROSPERO #241429) systematic review and meta\u2010analysis 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\u2010effects model to calculate pooled estimates. Primary outcomes included GC\/CT positivity, empiric treatment rates, and discordance between treatment and test results stratified by sex.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Overall GC\/CT positivity was 14% (95% confidence interval [CI] 12%\u201316%): 11% (95% CI 8%\u201314%) in females and 25% (95% CI 23%\u201326%) in males. Antibiotics were given to 46% (95% CI 38%\u201354%) of patients: 31% (95% CI 24%\u201337%) of females and 73% (95% CI 65%\u201380%) of males. Among patients with negative test results, 38% (95% CI 30%\u201347%) received antibiotics (i.e., potential overtreatment): 27% (95% CI 20%\u201334%) of females and 64% (95% CI 55%\u201373%) of males. Conversely, 39% (95% CI 31%\u201346%) of laboratory\u2010positive patients did not receive antibiotics (i.e., potential undertreatment): 52% (95% CI 46%\u201357%) of females and 15% (95% CI 12%\u201317%) of males.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>Significant sex\u2010based 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\u2010specific data.<\/jats:p><\/jats:sec>","DOI":"10.1111\/acem.70070","type":"journal-article","created":{"date-parts":[[2025,6,17]],"date-time":"2025-06-17T08:45:30Z","timestamp":1750149930000},"page":"1003-1016","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":7,"title":["Sex disparities in chlamydia and gonorrhea treatment in <scp>U.S.<\/scp> adult emergency departments: A systematic review and meta\u2010analysis"],"prefix":"10.1111","volume":"32","author":[{"given":"Rachel E.","family":"Solnick","sequence":"first","affiliation":[{"name":"Department of Emergency Medicine Icahn School of Medicine at Mount Sinai  New York New York USA"},{"name":"Previously at National Clinical Scholars Program, Department of Emergency Medicine University of Michigan  Ann Arbor Michigan USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rahi","family":"Patel","sequence":"additional","affiliation":[{"name":"Department of Emergency Medicine University of Texas Health Science Center  Houston Texas USA"},{"name":"Previously at Northeast Ohio Medical University  Rootstown Ohio USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ethan","family":"Chang","sequence":"additional","affiliation":[{"name":"SUNY Downstate College of Medicine  New York New York USA"},{"name":"Previously at University of Michigan  Ann Arbor Michigan USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Carmen","family":"Vargas\u2010Torres","sequence":"additional","affiliation":[{"name":"Department of Emergency Medicine Icahn School of Medicine at Mount Sinai  New York New York USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Maaz","family":"Munawar","sequence":"additional","affiliation":[{"name":"Previously at University of Michigan  Ann Arbor Michigan USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Carlin","family":"Pendell","sequence":"additional","affiliation":[{"name":"Previously at University of Michigan  Ann Arbor Michigan USA"},{"name":"Department of Psychology and Neuroscience University of Colorado Boulder  Boulder Colorado USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Judith E.","family":"Smith","sequence":"additional","affiliation":[{"name":"Taubman Health Sciences Library University of Michigan  Ann Arbor Michigan USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7276-0549","authenticated-orcid":false,"given":"Ethan","family":"Cowan","sequence":"additional","affiliation":[{"name":"Department of Emergency Medicine Icahn School of Medicine at Mount Sinai  New York New York USA"},{"name":"Department of Emergency Medicine Rutgers New Jersey Medical School  Newark New Jersey USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Keith E.","family":"Kocher","sequence":"additional","affiliation":[{"name":"Department of Emergency Medicine and Learning Health Sciences University of Michigan  Ann Arbor Michigan USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Roland C.","family":"Merchant","sequence":"additional","affiliation":[{"name":"USF Health, Department of Emergency Medicine Morsani College of Medicine at University of South Florida  Tampa Florida USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2025,6,12]]},"reference":[{"key":"e_1_2_12_2_1","unstructured":"Sexually Transmitted Infections Surveillance 2023. 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