Concurrent HIV-STD Testing by Patient Chief Complaint in An Emergency Department

Background: Despite recommendations for routine HIV screening in clinical settings, especially among high-risk individuals, few emergency department patients who are tested for STDs are concurrently tested for HIV.

Objectives: To determine if concurrent HIV-STD testing in emergency departments is influenced by the patient’s chief complaint at triage.

Methods: Patients tested for syphilis, gonorrhea, or Chlamydial infection (GC/Ct) in an emergency department in 2009 were evaluated for concurrent HIV testing. Chief complaint was categorized as potentially “STD-related symptoms” (genitourinary issues, abdominal pain, rash), “pregnancy-related”, or “unrelated”. The association between chief complaint and concurrent HIV-STD testing was assessed with multivariate logistic regression using generalized estimating equations.

Results: Over 6% (n=91/1442) of patients who presented with STD-related symptoms were concurrently tested for HIV – 87.8% and 3.0% among syphilis and GC/Ct testers, respectively. Only 1.4% (n=5/370) of patients with pregnancy-related complaints were concurrently tested for HIV and GC/Ct; none were tested for syphilis. Of patients presenting with unrelated complaints, 17.7% (n=144/812) were concurrently tested for HIV – 21.0% and 14.4% among syphilis and GC/Ct testers, respectively. Among syphilis testers, patients presenting with STD-related symptoms were more likely to have a concurrent HIV test than patients presenting with unrelated complaints (OR=7.51, 95% CI: 3.60-15.68). Among GC/Ct testers, patients presenting with STD-related symptoms or pregnancy-related complaints were less likely to have a concurrent HIV test than patients presenting with unrelated complaints (STD-related: OR=0.21, 95% CI: 0.13-0.36; pregnancy-related: OR=0.10, 95% CI: 0.03-0.29).

Conclusions: The frequency of HIV testing in patients who present with STD-related complaints differs based on the STD test that is ordered. A disconnect may exist between HIV and GC/Ct testing in an emergency department setting.

Implications for Programs, Policy, and Research: Providers should be educated as to the importance of concurrent HIV-STD testing for all patients, especially among those who present with potentially STD-related complaints.