Online tests for sexually transmitted infections – Friend or Foe? An analysis of providers in the United Kingdom

Abstract

ABSTRACTObjectivesOnline testing for sexually transmitted infections (STIs) may contribute to overcoming barriers to traditional testing such as stigma and inconvenience. However, regulation of these tests is lacking, and the quality of services is variable, with potential short- and long-term personal, clinical and public health implications. This study aimed to evaluate online tests available in the UK against national standards.MethodsProviders of online STI tests (self-sampling and self-testing) in the UK were identified by an internet search of Google and Amazon (June 2020). Website information on tests and care was collected, and further information requested from providers via an online survey, sent twice (July 2020, April 2021). The information obtained was compared to British Association for Sexual Health and HIV (BASHH) guidelines for diagnostics and standards of STI management.Results31 providers were identified: 13 self-test, 18-self-sample, and two laboratories that serviced multiple providers. Seven responded to the online survey. Many conflicts with national guidelines were identified, including: lack of health promotion information, lack of sexual history taking, use of tests licensed for professional use only marketed for self-testing, inappropriate infections tested for, incorrect specimen type used, and lack of advice for post-diagnosis management.ConclusionsVery few online providers met the BASHH national STI management guidelines standards that were assessed, and there is concern that this will also be the case in areas that were not covered by this study. For-profit providers were the least compliant, with concerning implications for patient care and public health. Regulatory change is urgently needed to ensure that online providers are compliant with national guidelines to ensure high-quality patient care, and providers are held to account if non-compliant.Key message boxOnline providers help overcome many barriers to STI testing and are increasingly popular, but quality of services is not assuredMany online testing services, particularly for-profit providers, did not comply with national guidelinesSubstandard services can lead to serious personal, clinical and public healthimplications, such as inappropriate testing, inappropriate antimicrobial prescribing, unnecessary emotional distress and missed diagnosesRegulatory change is required to ensure online providers comply with national guidelines and are held to account when they do not