Patients are being put at risk in the UK because very few sexually transmitted infection (STI) tests offered online meet official standards, experts have warned.
The NHS provides free in-person tests for STIs via its network of sexual health and genitourinary medicine clinics. Patients can also order tests via the internet from both NHS-commissioned and private providers, a practice that has become increasingly popular during the pandemic.
However, new research in the Sexually Transmitted Infections journal published by the BMJ found that few online STI test services meet national recommended standards, with independent sector providers the least likely to be compliant.
Online tests involve the user ordering a kit and either self-sampling by posting the specimen for laboratory analysis, or self-testing by interpreting the test themselves. National guidelines are provided by the British Association for Sexual Health and HIV and the Faculty of Sexual and Reproductive Healthcare.
Researchers at the London School of Hygiene and Tropical Medicine looked on Google and Amazon in June 2020 and found 13 services that offered self-test kits and 18 which offered self-sample kits, while two laboratories serviced several providers. All 13 self-test providers and 13 of the 18 self-sample providers were privately run, while all but one of the self-sample providers were from the UK.
The commercial self-sample providers, which advertised to those with symptoms, did not differentiate by STI symptom severity, and eight – seven private and one NHS-commissioned provider – offered no advice on accessing preventive treatment after exposure to HIV as recommended.
Self-test providers did not appear to offer any form of order of treatment for patients and five offered tests that were intended for professional use only. The research found there was often no health promotion information given, inappropriate infections were tested for, incorrect specimen types were used and there was little advice on what to do after a diagnosis.
Eleven self-test providers had at least one of their tests CE-marked, suggesting that the product conformed to European health, safety and environmental protection standards. Two claimed World Health Organization approval and one claimed US Food and Drug Administration accreditation.
One self-test provider marked its chlamydia and gonorrhoea tests with an NHS logo, describing itself as an NHS provider, but it was unclear if these products had been endorsed by the NHS. And while UK Accreditation Service accreditation was claimed for self-sample kits, there were no details of the specific laboratory service that had been accredited.
The research concluded “very few online providers” met national STI test standards.
It added: “The proliferation of providers that do not follow guidelines, in particular for-profit sites, jeopardises these advantages and puts users at risk. If current trends continue, online testing usage will increase, resulting in more online providers as demand rises.
“Regulatory change is required to ensure that the standard of care received online meets national guidelines to protect patients and the wider population from the repercussions of underperforming or inappropriate tests.
“If we do not act now, patients will continue to receive suboptimal care with potentially significant adverse personal, clinical and public health implications.”
