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Improving the diagnosis, treatment and outcomes of sexually transmitted infections

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Innovative sexual health solutions

The number of newly diagnosed sexually transmitted infections (STIs) in the UK continues to rise. 1 In 2023, there were 401,800 new diagnoses of STIs made by sexual health services in England. 1

Reducing the rates of sexually transmitted infections is a priority for the NHS. 2 NICE guidelines (“Reducing sexually transmitted infections” [NG221]) place emphasis on providing a service that meets the needs of the population that it serves, recommending that “local pathways are in place to link people, including underserved communities, to the best possible care.” 2

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The current method for diagnosing STIs follows three common steps.

1. Initial consultation

Patients present to sexual health services for a variety of reasons. At their first appointment, they will usually have a history taken by a specialist, be given an examination if appropriate, and then have a range of tests taken and sent for laboratory analysis. 3

2. Testing

Whilst the tests ordered may vary based on a variety of patient factors, the turnaround time for results should be four working days or less.1

This guideline is not always adhered to. A British Association for Sexual Health and HIV (BASHH) audit conducted in 2011 found that, compared to the 100% target for clinics receiving chlamydia results within the guideline time, a quarter reported that 25% of their results took longer than seven days to be reported. 4

3. Follow up appointment

Once results are received, the patient must be recontacted and potentially brought back to the clinic to discuss the results and commence appropriate treatment. 5

This can cause a number of difficulties, including issues contacting the patient and not attending follow-up appointments, which can lead to infections going untreated. 5

Research suggests that up to 30% of people do not return to the clinic after having had an STI test. 6

Opportunity to create a tailored sexual health testing pathway

Healthcare providers have opportunities to create STI pathways around patients – increasing access for at-risk groups.2

Roche Diagnostics is committed to developing advanced diagnostic solutions that address the challenges our sexual health services face, helping you to create a complete diagnostic pathway for sexually transmitted infections. 

The comprehensive STI testing menu offered by the cobas® 5800/6800/8800 systems can be complemented by the rapid testing provided by cobas® liat STI assays to provide a tailored and targeted STI testing pathway for both laboratories and clinics.

Test while they wait, treat before they leave.

Rapid point of care tests for STIs provide a clinically actionable result in 20 minutes7, which could help enable diagnostic confidence.  Clinicians are in control, defining who, when and where tests are clinically valuable and necessary.

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The benefits of rapid testing for STI diagnosis

Point of care testing (POCT) describes a system that allows specimen sampling and testing , with results delivered to the patient within one clinic visit. 5

Service models that allow more rapid turnaround times using same-day results can be feasible and cost-effective. 1

Rapid diagnosis of STIs are available using POCT, with an increasing recognition of the part these systems can play in managing patients with a possible STI. 1,8

waiting-room
Holding hands STI clinic

The benefits to patients and clinicians of POCT

Incorporating POCT for STIs into clinical settings allows healthcare professionals to provide definitive diagnoses and initiate appropriate treatment, all within the same visit. 8

Rapid testing results available to clinicians during the appointment would enable patients to receive treatment for infections immediately. This could potentially allow for more precision therapies with quicker and more appropriate care. 9, 10

Therapy guided by results can reduce empirical treatments (which may be given in some cases, such as where a partner has tested positive2) and contribute towards antibiotic stewardship, minimise loss to follow-up, decrease onward STI transmission, and lower the risk of complications. 9

Significantly, POCT may improve the patient experience by providing greater opportunities for counselling. 9

POC testing has been shown to have a positive impact on clinician time usage, with one study suggesting that POCT for chlamydia and gonorrhoea would reduce time per patient by ten minutes. 9

Outcomes from point of care testing

POCT allows for the most appropriate treatment to be given on the same day, avoiding delay and unnecessary therapies. 1

A modelling study showed that POC testing for chlamydia and gonorrhoea could lead to savings of £10 million per year across the country and an associated increase in quality-adjusted life years. 5

Other benefits the study found may include the avoidance of more than 95,000 inappropriate tests per year, the prevention of 189 cases of pelvic inflammatory disease, and 17,561 episodes of onward STI transmission annually. 5

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couple-at-festival

Sexual health services: a path to improvement for patients?

  • Both diagnosis and management of common STIs place a considerable burden on healthcare professionals and healthcare systems. 1
  • The impacts of STIs, both through the condition itself and from the potential complications, are felt by patients and broader society. 1
  • Current diagnostic methods may create a long wait for patients between initial consultation and diagnosis with treatment. 1,3
  • Rapid, point of care testing for common STIs has the potential to allow for earlier initiation of therapy, decrease healthcare costs, and reduce complications and ongoing transmission. 8

It all starts with a conversation

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References

1. UK Health Security Agency. STI prioritisation framework. Available at: https://assets.publishing.service.gov.uk/media/67376f07abe1d74ea7dade2d/STI-prioritisation-framework.pdf. Accessed: Jan 2025.

2. National Institute for Health and Care Excellence (NICE). Recommendations: Reducing Sexually Transmitted Infections: Guidance. Available at: www.nice.org.uk/guidance/ng221/chapter/Recommendations#improving-uptake-and-increasing-the-frequency-of-sti-testing. Accessed: Jan 2025.

3. National Health Service (NHS). Sexually transmitted infections. Available at: https://www.nhs.uk/conditions/sexually-transmitted-infections-stis. Accessed: Jan 2025.

4. 2011 Audit against the Key Performance Indicators in the BASHH MedFASH STI Management Standards. BASHH National Audit Group. H McClean https://www.bashh.org/_userfiles/pages/files/3787_1.ppt

5. Turner KM, et al. An early evaluation of clinical and economic costs and benefits of implementing point of care NAAT tests for Chlamydia trachomatis and Neisseria gonorrhoea in genitourinary medicine clinics in England. Sex Transm Infect. 2014;90(2):104-11.

6. Huppert JS, et al. Improving notification of sexually transmitted infections: a quality improvement project and planned experiment. Pediatrics. 2012;130(2):e415-22.

7. cobas® liat CT/NG/MG package insert 10147563190-01EN Doc Rev. 1.0 October 2024

8. Riegler AN, et al. Point-of-care testing for sexually transmitted infections. Clin Lab Med.2023;43:189–207.

9. Gaydos CA, et al. A narrative review of where we are with point-of-care sexually transmitted infection testing in the United States. Sexually Transmitted Diseases. 2021;48(8S):S71-S77.

10. Adams EJ, et al. Mapping patient pathways and estimating resource use for point of care versus standard testing and treatment of chlamydia and gonorrhoea in genitourinary medicine clinics in the UK. BMJ Open. 2014;4(7):e005322.