Testing for sexually transmitted infections: a brave new world?

The sensitivity of nucleic acid amplification tests has made it possible to use non-invasive specimens, such as urine or vaginal swabs, for the diagnosis and screening for major bacterial sexually transmitted infections (STIs). As these specimens can be stored and transported at ambient temperatures, there has been a proliferation of internet-based STI testing services that are advertised as private, safe and confidential. The tests used and the quality of the testing on these internet services are unknown. Simple rapid tests for STIs are also available for purchase from the internet or “over the counter” from pharmacies or stores. Very few countries regulate STI tests sold. Even among the countries that regulate diagnostics for STIs, standards for evaluations are lacking, with the result that product inserts often contain inflated claims of test performance. Preliminary evaluations of some of the rapid chlamydial and gonococcal tests showed good specificity but limited sensitivity. The internet has been recognised in recent years as a new risk environment for STIs in both men and women, and efforts at internet-based sexual health promotion are hopefully reaching those at risk. However, this trend in STI testing and the lack of regulatory control should raise considerable concern over the potential for false-positive or false-negative results. It remains unclear how many individuals with a positive result would access appropriate treatment and counselling, and notify their sexual partners for testing and treatment. There needs to be closer examination of the implications of these services on STI control programmes.

Imagine a teenager who just discovered that she has vaginal discharge. She has been in two short sexual relationships and has not been consistent with condom use. She is worried but is too scared to tell her parents or her sexual partners. She does not want to go to her family doctor or …