Background Over 350 million (M) prevalent cases of curable STIs are estimated worldwide: 100 M chlamydia (CT), 36M gonorrhoea (NG), 187 M trichomonas, and 36 M cases of syphilis. 34 M HIV infections are estimated worldwide. Human papillomavirus infections (HPV) and herpes viruses (HSV) are highly prevalent, yet are not often diagnosed. Technology has led to sensitive nucleic acid amplification tests (NAATs), allowing use of non-invasive specimens, like vaginal swabs and urine. NAATs are widely available, and novel approaches include point-of-care (POC) tests, internet availability, and self-testing. New serological tests have advanced diagnoses of HIV, HPV, and HSV. Yet, challenges to diagnosing STIs continue.

Methods To discern where we are heading in the field of HIV/STI diagnostics research, new assays and new approaches to enhance care were reviewed.

Results There are commercial NAATs for CT/NG by 4–5 companies. Some are available on expensive robotic platforms, limiting their use in resource-constrained settings. Additionally, a new CT/NG NAAT that can return results in 90 minutes is available. Other rapid NAAT and hybridization POC assays are in the pipeline.

There are two NAATs and a POC test for trichomonas. POC syphilis serology tests have proliferated, which is important to syphilis elimination. Several platforms offer NAAT tests for HPV and there is a NAAT for HSV ulcers. Rapid HIV POC and 4^th generation tests have advanced earlier detection of HIV. A home oral-fluid HIV test can be purchased in the US. Patients perform their own HIV tests in Emergency Departments with excellent accuracy. Internet availability of select STI tests for home collection/outreach programmes offer novel approaches to increasing options offered to individuals at risk.

Conclusions Learning how to wisely and effectively use these tools can improve the detection of STIs and provide cost-effective ways to increase the number of patients being treated.