“Anyone who has sex can get an STI, but it’s important to understand that some groups are more affected in general, and untreated STIs can lead to serious health problems,” he said. “Trying to get results quickly to individuals can not only tailor our antibiotic response but also prevent some of the other health problems that can occur with untreated STIs.”
In 2025, he said, any case of congenital syphilis is “an indictment of our dilapidated public health system.”
Dr. Hazra shared the case of a 19-year-old woman who presented to the ER with four days of acute dysuria.
Her urinalysis on presentation showed moderate pyuria. She was treated for simple cystitis and discharged with a short course of nitrofurantoin. “The clinician in the ER was astute enough to send for STI screening,” he said, noting that they could have considered it a “slam dunk” UTI case. “We need to be thinking about STI screening all the time, in the midst of the current STI epidemic we are in.”
The final urine culture was without growth, but the gonorrhea/chlamydia nucleic-acid–amplification test results, returned the next day, revealed chlamydia. “The turnaround time of our lab is about a day to get some of these results back, or at least within a shift or two,” he said. The ED staff attempted to follow up, but the patient’s phone number was disconnected and her MyChart inactive.
“An amazing clinical pathologist leads our efforts, but even with our amazing turnaround times, people still get missed,” he said.
A 19-year-old with dysuria seeking care in the ED rather than somewhere she can receive longitudinal primary care is “one of the major obstacles we face,” Dr. Hazra said. “We see a majority of our patients coming to the ER for primary care complaints. That’s not unique to STIs,” but urgent care sites and the ED are relied upon for sexual health specifically, and that role is important to understand when implementing novel STI diagnostics is considered, he said.
The patient returned to the ED 10 days later with progressive dysuria, frank vaginal discharge, and progressive pelvic pain. She was febrile and tachycardic on presentation. Her exam was consistent with pelvic inflammatory disease, and imaging demonstrated a right tubo-ovarian abscess. She was admitted for IV-administered antibiotics and surgical intervention, leading to the loss of her right fallopian tube.
“This is unfortunately not an uncommon story we see in our ER,” Dr. Hazra said. Patients with undiagnosed or missed STIs eventually return for care, but often with complications, “not to mention potential ongoing downstream transmission of that STI to their sexual partners.” All of this, he said, points to the importance of reliable and timely test results.
In the current laboratory-based testing model, though, delays of 24 to 72 or more hours are standard. “A lot of our federally qualified health centers rely on outside commercial labs to run their STI screening. Often it will take days for those results to get back to the system and be able to be delivered to that patient,” he said. Access to testing, too, can be insufficient in resource-limited settings like FQHCs. And the no-show rate for follow-up care is high, given the fragmented care systems of the U.S.
“We have an outdated testing framework that often fuels inequalities,” Dr. Hazra said. “Our nation’s STI response is too narrowly focused on individual risk and behavior, ignoring the structural barriers to diagnosis and care.” Laboratory-based testing, in his view, can reinforce delays, stigma, and disengagement, especially in populations that are marginalized. “The dominant model fails to meet people where they are,” he said. It places on patients the burden of seeking care at a well-resourced clinic. “A modern, equity-driven approach must shift toward a point-of-care testing model that enables immediate diagnosis and treatment, at the patient’s discretion, where the patient feels empowered or in control of their testing modalities.”