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The definition of a near-patient, or “point-of-care” test (POCT), is an investigation carried out in a clinical or non-clinical setting, or in the patient’s home, for which the result is available without reference to a laboratory, perhaps rapidly enough to affect immediate patient management.
The characteristics of an ideal POCT, as outlined by the World Health Organisation Sexually Transmitted Diseases Diagnostics Initiative in 2001 (http://www.who.int/std_diagnostics/about_SDI/priorities.htm), should fulfil the ASSURED guidelines; it should be affordable by those at risk of infection; sensitive, with few false negatives; specific, with few false positives; user friendly or simple to perform, with minimal training; rapid, to enable treatment at the first visit; robust, not requiring refrigeration or heating; equipment-free; and delivered to those who need it. Unfortunately, for most sexually transmitted infections (STIs), such tests do not yet exist, and our perception of what is currently available or possible is often overambitious. Six years ago, Professor Peter Borrelio, Director of the Public Health Laboratory Services at the Central Public Health Laboratory, Cardiff, UK, suggested that “a single microchip could be programmed to perform a range of tests for different organisms on a single pinprick blood specimen taken from a patient. The chip could then tell the GP [general practitioner], or the patient themselves, what sort of organism is causing their infection”.1 Unfortunately, technology has not advanced sufficiently to make this a reality. Currently available tests are not as rapid, or as simple as, for example, a pregnancy test or urine dipstick. Much of the published literature focuses on theoretical utility rather than providing data to support integration into routine clinical practice. Of course if a POCT existed that fulfilled the World Health Organisation recommendations outlined above, genitourinary medicine services could benefit enormously; however, currently these tests are not sufficiently …
Competing interests: None declared.
This is a transcription of a verbal debate given at the HPA conference 2005 between GD and PW. Both authors argued from extreme angles in the interest of a lively debate.
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