In 2003, the CDC estimated that 1 million people in the USA were living with HIV/AIDS, and 25% were undiagnosed. For many such patients the ED may be the only contact with the health care system. This study assessed compliance with CDC and USPTF guidelines for HIV testing in patients seeking evaluation for STDs in a regional cohort of emergency departments. 13927 patients patients underwent screening for STDs during the study period. Only 397 (2.85%) also received HIV screening while 107 (0.8%) received both HIV and syphyllis screening as per federal recommendations.