Background:
Numerous studies have documented that ED patients have higher STD rates than prevail in their communities overall, and survey data show that a substantial proportion of STD patients are treated in EDs. Because of these factors, cost-effectiveness analyses have shown that STD screening in EDs can be cost-effective. HIV screening is also recommended for ED patients. Surveys of ED physicians have shown that barriers to screening include time constraints and follow-up concerns.

Objective:
To use a national physician survey conducted in 1999 (4226 responses, response rate 70.2%) to determine the extent of STD and HIV screening by ED physicians compared to physicians not practicing in EDs.

Method:
We determined the percent of ED and non-ED physicians screening for each of syphilis, gonorrhea, chlamydia, and HIV from the survey. The survey did not have patient-level data. We used data for practice location, physician gender, and patient demographics of race and gender from the survey in multivariate logistic regressions to determine adjusted odds ratios.

Result:
ED physicians were less likely than non-ED physicians to screen for syphilis, gonorrhea, chlamydia, and HIV in all patient groups (men, non-pregnant women, and pregnant women). Among ED physicians, screening rates ranged from 5.2% for HIV in women (versus 22.9% of non-ED physicians) to 26.9% in women for chlamydia (versus 37% of non-ED physicians). The differences in screening rates were significant at p < 0.05 except in men for chlamydia and gonorrhea. The adjusted ORs varied from 0.103 (for HIV screening of pregnant women) to 0.926 (for chlamydia screening of men).

Conclusion:
ED physicians screen for STDs and HIV less frequently than providers in other settings, despite studies showing that ED patients are at elevated risk for STDs and HIV.

Implications:
Programs should seek to increase ED clinicians' acceptance of and ability to conduct STD and HIV screening.