Offering young people testing kits for sexually transmitted infections (STIs) over the internet almost doubles testing uptake compared with inviting them to a clinic, research suggests.

In 2016 alone there were more than 417,000 diagnoses of sexually transmitted infections in England, including gonorrhoea and chlamydia, with rates of STI diagnoses generally higher among young people. While the use of condoms can help to prevent the spread of STIs, a recent survey found that nearly half of under-25s questioned did not use one when having sex with a new partner.



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With time of the essence when it comes to diagnosis, new services have been developed to boost testing, including so-called “e-STI testing”, whereby testing kits for gonorrhoea, HIV, syphilis and chlamydia can be requested by individuals over the internet, with sexual health information also made available. The kits are then posted out, with samples returned by post and results given by phone or text message.

The latest study suggests the approach could indeed increase testing uptake.



“It is a really good news story, we are really delighted,” said Dr Caroline Free, co-author of the study from the London School of Hygiene and Tropical Medicine. “It is good news that it increases testing and it is really good news that it does that in high risk groups as well as lower risk groups.”

E-STI testing schemes have attracted criticism from some, whose arguments include the accusation that the services are being rolled out as a sticking plaster for funding cuts to clinics and don’t offer the chance to pick up other issues or give counselling. However, others have argued that it is a convenient approach that could encourage testing.

Writing in the journal Plos Medicine, a team of researchers based at a number of London institutions describe how they carried out a trial involving more than 2,000 participants aged between 16 and 30 from the boroughs of Lambeth and Southwark to probe whether e-STI services improved testing rates compared to conventional face-to-face services.

The team randomly split participants – recruited via posters in universities, bars, and on social media – into two groups and sent a text message inviting them to have an STI test, either at a walk-in sexual health clinic or by ordering an STI-testing kit online. The latter group were also asked to complete a short form – those who reported symptoms, or appeared to have complications such as drug problems, were directed to a clinic but could continue with the postal test if they wished.

After analysing patients’ records and taking into account missing data, the team reveal that just under 27% of those invited to a clinic had completed a test by six weeks, compared to 50% of those invited for e-STI testing – the large majority of whom did indeed use the postal kit.

The results also hint that more STI diagnoses were made for the group invited for an e-STI test, but the researchers note that a greater number of participants would be needed to confirm this, and not all relied on the postal test; some instead went to a clinic.

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“[E-STI testing] is more convenient; and for some people they would rather do a test like this in the privacy of their home than attend a clinic,” said Free, adding that the study suggests e-STI testing should be commissioned alongside existing sexual health services.

Dr Mark Lawton of the British Association for Sexual Health and HIV and a sexual health consultant in Liverpool, welcomed the study. “Anything that increases testing rates has got to be seen as a good thing,” he said. “For the right people the postal testing might be an acceptable way.”



But, he added, it was not clear why rates were lower for those invited to a clinic, while there are concerns that a move to e-STI testing is linked to budget cuts for clinics. “This should be in addition to, not instead of, traditional sexual health services which are best suited for people who have symptoms and also identifying vulnerable groups and supporting those,” he said.

The National Aids Trust’s director of strategy, Yusef Azad, agreed. “Sexual health clinics need to be better funded so we can have both e-STI testing and end the long waiting times that are now building up for face-to-face appointments,” he said.



