Introduction Chlamydia trachomatis and Neisseria gonorrhoeae testing guidance recommends extragenital screening with locally validated nucleic acid amplification tests for patients reporting receptive oral and/or anal sex, with anatomical sites sampled and tested separately. Within-patient pooled sampling (PS) could be more cost effective for triple -site (genital/oral/anal) testing, but may require establishment of complex management pathways and loss of information to guide risk assessments and treatment.

Objectives We reviewed the evidence on the cost effectiveness of PS and explored current opinion and practice among genitourinary medicine (GUM) clinics in England.

Methods Global literature on PS was reviewed. A web-based survey was distributed to GUM clinical leads throughout England on 11/02/16.

Results Published evidence supports multi-patient combined aliquot PS for population screening, however evidence for within-patient PS is sparse. 44/223 (19.7%) services responded to the web survey. One service (2.3%) reported current PS and 2 (4.5%) were awaiting implementation. Of the 41 services not pooling, 4 (9.8%) were considering future implementation. Commonly reported barriers to implementation of PS were: loss of infection site information (30/44, 68.2%), absence of national guidance (26/44, 59.1%), and decreases in assay sensitivity/specificity (17/44, 38.6%). Only 6/44 (13.6%) considered the current level of evidence sufficient to support PS, with 35/44 (79.5%) requesting further validation studies, 34/44 (77.3%) national guidance, and 23/44 (52.3%) more cost effectiveness data.

Conclusion PS is currently uncommon in GUM services across England. Best practice evidence-based guidance on the appropriate use of PS will be needed if PS is introduced more widely as part of cost-saving measures.