Photo Credit: iStock.com/FotografiaBasica

A recently published study revealed significant sex-based disparities in emergency department empiric antibiotic treatment for gonorrhea and chlamydia.

Significant sex-based disparities exist in emergency department (ED) empiric antibiotic treatment for gonorrhea (GC) and chlamydia (CT), with females 3.5 times more likely than males to be potentially undertreated, according to a study published in Academic Emergency Medicine.

“Local studies have identified sex-based disparities in sexually transmitted infection (STI) care, with females potentially receiving less empiric treatment than males,” wrote corresponding study author Rachel E. Solnick, MD, MSc, of Icahn School of Medicine at Mount Sinai, and colleagues. “This study evaluates how STI treatment aligns with laboratory-confirmed results to quantify potential overtreatment and undertreatment rates and investigates sex differences for these outcomes.” 

Study Scope

The researchers conducted a preregistered systematic review and meta-analysis, synthesizing 19 US ED studies published from 2010 to 2025, which covered 32,593 adult visits in which patients were tested for GC and CT. Pediatric-only cohorts were excluded to focus on typical adult practice patterns.

Sex-Skewed Discordance

Overall, 14% of patients tested positive for either infection; however, antibiotics were administered in 46% of encounters, according to the findings. Discordance was strikingly sex-skewed: Men received empiric therapy in 73% of cases, but women in only 31%. Additionally, results showed that among laboratory-negative patients, 64% of men and 27% of women were potentially overtreated. Conversely, 52% of women with infections and 15% of men with infections left the ED without antibiotics—an undertreatment gap that the authors called “clinically unacceptable.”

“These findings underscore critical sex disparities in empiric antibiotic treatment in EDs,” the study team stated.

Why the Gap Matters

According to the research team, delayed laboratory turnaround compels clinicians to treat before results are known. The authors observed that “reducing undertreatment is critical to preventing complications from untreated infections and reducing the spread of STIs,” adding that, for women, missed therapy heightens risks of pelvic inflammatory disease, adverse pregnancy outcomes, and HIV acquisition. Overuse in men, meanwhile, increases resistance and unnecessary adverse drug events.

Potential Solutions

The researchers noted that rapid molecular diagnostics that deliver results before discharge could sharply reduce both over- and undertreatment.

“Balancing these risks in the absence of STI laboratory results requires consideration of the patient’s risk factors,” the authors noted, arguing that point-of-care tests should be prioritized for high-volume EDs. Shared decision-making, reliable telephone follow-ups, and expedited partner therapy during callbacks were listed as additional avenues to narrow the treatment gap while preserving antimicrobial stewardship.

Striking a Balance

The authors concluded that their findings highlight a persistent reliance on clinical judgment that disadvantages female patients, possibly magnified by implicit bias and asymptomatic presentation. They called for prospective trials evaluating how rapid diagnostic implementation and clinician-awareness programs affect sex-based equity in STI management, adding that, until such measures are routine, EDs remain challenged to strike a balance between timely treatment and prudent antibiotic use—an equilibrium that, according to the authors, “must be a clinical and public-health priority.”