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

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

• Epidemiology and Determinants of Health
  • Determinants of Health
• Determinants of Health
  • Health services
  • Stigma/discrimination
• Population(s)
  • General HIV- population
• Prevention, Engagement and Care Cascade
  • Prevention
• Prevention
  • Sexual risk behaviour
• Testing
  • Testing
• Co-infections
  • Chlamydia
  • Gonorrhea
  • Syphilis
• Health Systems
  • Governance arrangements
  • Financial arrangements
  • Delivery arrangements