Few online sexually transmitted infection test services meet national standards

Few online sexually transmitted infection test services in the UK meet national recommended standards – with independent sector providers the least likely to be compliant, according to research published in the journal Sexually Transmitted Infections.

The researchers warned their findings had concerning implications for patient care and public health, and called for urgent regulatory change to ensure full compliance.

Online tests are either self-sampling, where the user orders a kit and takes a specimen themselves before posting it for laboratory analysis, or self-testing, where the user takes a specimen and interprets the test result themselves.

Online testing for sexually transmitted infections (STIs) is subject to limited regulatory oversight. But the British Association for Sexual Health and HIV (BASHH) and the Faculty of Sexual and Reproductive Healthcare (FSRH) have issued comprehensive national standards and guidelines covering all aspects of these services.

The researchers found 31 online providers via Google and Amazon in June 2020. Of these, 13 offered self-test kits, while 18 offered self-sample kits. They also found two laboratories servicing several providers.

All 13 self-test providers and 13 of the 18 self-sampling providers were privately run. All but one of the self-sample providers were from the UK.

The researchers analysed the information on the tests and associated services on each of the websites, and requested further details from each provider.

Just seven providers completed the questionnaire. These responses, together with the website information from all the providers, showed that few of them complied with the national guidelines and standards.

The commercial self-sample providers, who advertised to those with symptoms, didn’t differentiate by symptom severity. And eight (seven private, one NHS-commissioned) didn’t offer any advice on accessing preventive treatment after exposure to HIV, as recommended.

Self-test providers didn’t appear to provide any form of triage, and five offered tests that were intended for professional use only.

The range of eligible organisms for testing varied, although all self-sample providers offered tests for chlamydia and gonorrhoea. Two even claimed to test for organisms not included in routine NHS testing, even though these organisms aren’t considered STIs.

There was often no health promotion information given, and little in the way of sexual history taking. Inappropriate infections were tested for, incorrect specimen types were used, and there was little advice on what to do after a diagnosis.

The researchers said: ‘Very few online providers met the national STI management standards assessed, and there is concern that this will also be the case for service provision aspects that were not covered by this study.’

Online testing offers a convenient and flexible option for users, they point out. ‘However, the proliferation of providers that do not follow guidelines, in particular for-profit sites, jeopardises these advantages and puts users at risk.’

They added: ‘If we do not act now, patients will continue to receive suboptimal care with potentially significant adverse personal, clinical and public health implications.’

Photo by Mufid Majnun