The ability to increase access to STI and HIV diagnoses and treatment through home testing has been demonstrated to be both acceptable and popular and should herald a bright future. But the lack of appropriate regulation and the financial imperative for commercial organisations of profitability is having a number of unintended consequences. 1) How is the data being shared with public health, which produces population STI and HIV statistics? Failure to integrate all sources will result in an incomplete picture affecting public health priorities. 2) In the United Kingdom a number of on-line providers are offering premium multi-plex testing and in some cases individual NAAT testing for Ureaplasma urealyticum, Mycoplasma hominis, Mycoplasma genitalium and Gardnerella vaginosis for which there is a) no evidence that detecting and treating them in asymptomatic individuals does more good than harm and/or b) no association with disease at low load. Companies may refer patients to Wikipedia for information or develop their own with misleading statements such as ‘If Ureaplasma infection is left untreated, there is an increased risk of getting other STIs, including HIV…. In women there is also an increased likelihood of infertility if there is a prolonged Ureaplasma infection.’ This results in over-diagnosis, unnecessary patient anxiety and inappropriate antimicrobial therapy increasing the risk of antimicrobial resistance to tetracycline, macrolides and metronidazole. 3) The performance of these multi-plex assays is also unclear. Which is of relevance in the diagnosis and treatment of chlamydia, gonorrhoea, trichomonas and M. genitalium which has implications for patients and public health STI control programmes. Should we be concerned and if so what needs to be done? We need regulation fit for purpose with mandatory sharing of anonymised data and governance from national/international expert bodies on STIs and HIV – but who will take ownership of this and fund it?
Disclosure No significant relationships.
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