DOI: 10.1111/1742-6723.70298 ISSN: 1742-6731

Screening for Asymptomatic Sexually Transmitted Infections in Emergency Departments: An Integrative Review of Public Health Outcomes

Joshua Wilcox, Faye Jordan
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ABSTRACT

Objective

To synthesise evidence on opportunistic screening for asymptomatic sexually transmitted infections and bloodborne viruses (STI/BBV) in emergency departments (EDs), focusing on detection, public health outcomes and feasibility.

Methods

An integrative review was conducted using Whittemore and Knafl's framework. PubMed, EBSCO, the Cumulative Index to Nursing and Allied Health Literature (CINAHL), Cochrane, and Embase were searched (2012–2024). Eligible sources included quantitative, qualitative, mixed‐methods and policy papers. Studies were appraised with the Mixed Methods Appraisal Tool (MMAT) and synthesised thematically.

Results

A total of 20 studies were included. Thematic synthesis identified four key domains: routine or opt‐out ED screening increased case detection and was cost‐effective; barriers included privacy concerns, workflow constraints and low risk perception; behaviour‐based eligibility better aligned screening with actual risk factors, whereas population‐based approaches often misclassified exposure; and implementation was facilitated by confidentiality safeguards, streamlined workflows, self‐collection and electronic prompts.

Conclusion

Routine, opportunistic asymptomatic STI/BBV screening embedded within emergency department workflows reliably increases case detection of Chlamydia trachomatis , Neisseria gonorrhoeae , syphilis, and HIV and is cost‐effective. Behaviour‐based eligibility better aligns screening with actual transmission risk than identity‐ or population‐based stratification, and implementation strategies that safeguard confidentiality, support self‐collection, deliver results discreetly, and integrate electronic prompts into routine workflows consistently improve acceptance and feasibility. For Australian emergency departments, the evidence supports adopting routine, opportunistic, behaviour‐based screening as a feasible, high‐yield public health intervention. Conclusions are bounded by the predominance of United States studies, limited longitudinal follow‐up, and the use of a single reviewer.

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