Diagnosing STIs: faster tests for chlamydia and gonorrhoea can help reduce the spread of disease
Let’s be honest – nobody relishes the prospect of visiting a Sexual Health clinic. Those who make the trip often have symptoms and are worried that they may have an infection. In many cases, they face an anxious wait for results to come back from the lab.
When I started working in the public health system in the UK, parts of the patient experience of Sexual Health services were far from ideal. Health professionals would take samples which were collected daily and taken to a lab. Results were sent back to the clinic around one week later and then there was further delay in notifying the patient of their results. For patients, it was a worrying wait.
One of the most pioneering clinics was at Dean Street Express (DSE) in London’s Soho district. There, the team developed a new clinical workflow which was more patient-centred and convenient but also delivered public health benefits and potential savings to the whole system.
Patients attend the clinic where samples are taken and analysed using the on-demand molecular diagnostics system onsite. Results are delivered to the patients within three or four hours. For STIs like chlamydia and gonorrhoea, patients receive a text message with their test result.
If patients get the all clear, they get on with their lives; if the test is positive, they receive a link that allows them to book an appointment so that treatment could be initiated as soon as possible. (Patients receive a phone call from a health professional, rather than a text message, if they test positive for HIV, hepatitis and syphilis.)
Patients told us that getting results more quickly was much better than having to wait, 94% of patients rated the new experience as ‘excellent’. If the test is positive, they have an early opportunity to tell partners who may also need treatment. If the test is negative, they can resume normal activity – and may be spared the awkward conversation with current or former partners.
For some, the thought of making their first appointment at an STI clinic and then enduring a week of waiting can be off-putting. Knowing you can attend in the morning and have a result that afternoon brings people to clinics who might otherwise have not attended.
Lower infection rates
For the wider health system, there are further benefits. For every two people diagnosed with an infection, one partner is spared exposure to the disease. Research at DSE shows fast testing made the time from testing to patient’s receiving results almost nine times faster than standard lab-based diagnostics. Based on around 60,000 fast tests, 196 new cases of chlamydia and gonorrhoea were prevented at DSE alone, leading to annual savings (from fewer partners exposed and reduced partner attendances) of £124,000 or €142,000. *
Early diagnosis also contributes to the fight against AMR. New drug-resistant strains of gonorrhoea are a major public health challenge. There is a risk that the disease could become untreatable if our last line of antibiotic defences becomes ineffective.
Patients presenting for traditional testing are often given antibiotics while they wait for a diagnosis. Sometimes partners are also treated in case they are infected. In some cases, the lab results show patients did not have a bacterial infection, meaning antibiotic use was inappropriate. With fast testing, on the other hand, clinicians and patients are happy waiting a few hours for the results before initiating antibiotic treatment.
In my experience, attitudes in this field are shifting. Patient expectations have changed – there are very few things in modern life where we have to wait nine days for an answer. Faster test results were once seen as a nice-to-have but are quickly becoming a must from the perspective of patients, public health and health system efficiency.
*Whitlock GG et al. Int J STD AIDS. 2017 Jan 1:956462417736431