Most people are now familiar with using rapid diagnostic tests with many people regularly using lateral flow tests for COVID-19. Within sexual health clinics, rapid testing for HIV has been widely used for a number of years but using rapid tests for other sexually transmitted infections (STIs) such as chlamydia and gonorrhoea is not yet standard practice.
Our recent paper published in Therapeutic Advances in Infectious Disease provides further evidence that rapid near patient testing for chlamydia and gonorrhoea in sexual health clinics in England results in better clinical management of patients. We assessed data from three sexual health clinics where a new 30-minute test for chlamydia and gonorrhoea was used in place of laboratory testing. The analysis found that using the rapid test resulted in fewer unnecessary treatments in people without infection and a quicker time to treatment in people with chlamydia.
Chlamydia and gonorrhoea are among the most common STIs and around 2 million people are tested for chlamydia and gonorrhoea in sexual health services (SHSs) each year in England [1]. The turnaround time for results can vary from one or two days in many urban clinics to more than 8 days in some areas [2-4]. This means that instead of waiting for the result before treating people, many clinics decide to treat patients when they first attend if they have symptoms, or their partner has a confirmed infection. Inevitably, this means that some people who do not have an infection receive unnecessary antibiotics whilst people with an infection, but no symptoms must return to receive treatment on a subsequent day, risking onward transmission in the meantime.
Rapid testing for chlamydia and gonorrhoea within clinics with new highly accurate tests would allow clinics to prescribe antibiotics during the patients first attendance based on a diagnostic test result. As well as reducing time to treatment and avoiding unnecessary antibiotics there is some evidence that these tests could lead to resource savings to the health service as a consequence of reducing illness associated with these infections, onward transmissions and the number of return appointments.
Aquarius worked with three sexual health services in England who recorded data on the resources used for testing and treating patients for chlamydia and gonorrhoea. Data was also collected once the clinics started using the 30-minute binx Health rapid test for chlamydia and gonorrhoea. Data on clinical outcomes, patient numbers and resource use (such as staff time and consumables) were collected for 225 patients in total allowing comparison before and after the introduction of the rapid test.
The results showed that following the introduction of the chlamydia and gonorrhoea rapid test, the average waiting time for results went from 6.6 to 0 days and the average time to treatment for chlamydia went from 10 to 0 days (i.e., people were treated on the day they attended the clinic). The average cost per patient of testing and treating these infections increased slightly from £50.88 to £61.55 although this varied between clinics.
Our paper supports existing evidence that point of care testing for STIs can improve patient clinical care. This work was done in parallel with developing a digital tool to allow sexual health services and trusts to assess the impact of adopting point of care tests for chlamydia and gonorrhoea taking into account local prevalence and patient numbers. Follow the link to read more about other digital tools developed by Aquarius.
The full paper can be found here: https://journals.sagepub.com/doi/pdf/10.1177/20499361211061645
This work was part of an Innovate UK funded collaborative project with binx Health and is one of many pathway mapping projects which Aquarius has led for diagnostic companies and healthcare providers in the UK and internationally. If you are interested in finding out more about Aquarius and the evidence generation we provide, please email info@aquariusph.com.
References
- UK Health Security Agency, Sexually transmitted infections and screening for chlamydia in England: 2021 Report. Available from: https://www.gov.uk/government/statistics/sexually-transmitted-infections-stis-annual-data-tables/sexually-transmitted-infections-and-screening-for-chlamydia-in-england-2021-report#national-chlamydia-screening-programme
- Public Health England. Audit report on turnaround times National Chlamydia Screening Programme. [Internet]. 2014 Nov. Available from: https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/380604/NCSP_audit_report_turnaround_times.pdf
- Harding-Esch E, Sherrard-Smith E, Fuller SS, et al. P65 Sexual behaviour in the time period between being tested for chlamydia and receiving test result and treatment. Sex Transm Infect [Internet]. 2015 Jun 1 [cited 2019 Feb 27];91(Suppl 1):A37–A37. Available from: https://sti.bmj.com/content/91/Suppl_1/A37.1
- British Association for Sexual Health and HIV (BASHH). Standards for the management of sexually transmitted infections (STIs) (Draft for public consultation) [Internet]. 2019 Jan. Available from: https://www.bashhguidelines.org/media/1210/final-consultation-draft-of-standards-for-the-management-of-stis-180119.pdf