The International Union Against Sexually Transmitted Infections (IUSTI) World Congress was recently held in Sydney, Australia. To better understand the landscape of sexually transmitted infections (STIs) and where diagnostic elements play a role, the Lab Insights team attended the conference to hear insights from global experts.

Increasing access to STI care through diagnostics

Increasing access to diagnostic services remains a crucial factor in improving public health outcomes, especially for STIs. Addressing barriers such as stigma and fear, which often prevent high-risk populations from seeking care, can lead to more effective management and control of these conditions. Dr Liu Po Yu of Taichung Veterans General Hospital (Taiwan) highlights the importance of empowering patients with knowledge to encourage proactive health management. When patients are well-informed, they are better equipped to make decisions that lead to longer healthier lives.

Dr Jason Ong of the Melbourne Sexual Health Centre and A/Prof Angela Kelly-Hanku of the University of New South Wales both emphasise the importance of making diagnostic services accessible and user-friendly. Dr Ong suggests incorporating self-testing as a powerful tool to democratise access to STI testing, mentioning the success of vending machines in rural Australia where 70% of users had never tested for an STI before. A/Prof Kelly-Hanku advocates for reducing hierarchical structures in accessing diagnostics and improving health literacy, as she speaks from her experience working in rural communities.

One critical angle raised was the importance of integrating community voices in the planning and deployment of diagnostic services to get over the stigma of having an STI. By involving various communities, diagnostic tools and their deployment can be tailored to each community’s needs.  Dr Liu points out that no one test fits all, thereby underlining the need for adaptable, user-friendly solutions. One such solution could be the use of point-of-care tests that offer quick test results. Coupled with the normalisation of home testing, this could be the way forward to get more people tested.

Innovations in diagnostic services alone is not enough. The ecosystem must band together to ensure that care is offered in a single continuum to ensure increased access to STI care. With a comprehensive and integrated approach,  more individuals will be able to receive the timely and appropriate care they deserve.

Not all point-of-care diagnostics are created equal

While point-of-care (POC) diagnostics have been introduced in several resource-strained settings, promising quicker test results, cost-effectiveness, and greater patient accessibility, the reality is more complex. POC diagnostics have shown success in rural populations in Australia and other parts of the Pacific, delivering critical primary care in culturally safe ways. However, their effectiveness in similar settings is not guaranteed. Variations in infrastructure, healthcare practices, and community engagement can significantly impact the success of POC testing, highlighting the need for tailored approaches that consider the unique challenges of each environment.

The most notable example discussed at the conference was the Philani Ndiphile Trial currently underway in South Africa. STIs are prevalent in the country, particularly among pregnant women. This trial targets four primary healthcare facilities and focuses on women attending antenatal clinics in a rural area. It is structured as a randomised controlled hybrid effectiveness-implementation trial. Although the trial has not yet concluded, initial findings were shared at the conference. A key takeaway was that, despite having a designated waiting area for women during the 90-minute turnaround time, most opted not to wait for their results. Follow-up telephone calls were made to those who could not wait, but the loss to follow-up was notably high. The trial organisers emphasised the urgent need for a point-of-care test that delivers results in 30 minutes or less to enhance patient impact and improve follow-up rates.

Testing can help with growing antimicrobial resistance

Another prominent theme featured at IUSTI this year was the rising concern of antimicrobial resistance in several increasingly common STIs, particularly with broad-spectrum antimicrobials [1]. As Professor Catriona Bradshaw of Melbourne Sexual Health Centre put it “We now commonly encounter untreatable infections.”

STI infections often remain largely asymptomatic, with their natural history varying significantly from person to person. As Professor Nicola Low, Professor of Epidemiology and Public Health at the University of Bern, noted, this variability results in “no accurate reflection of the burden of the disease.” Screening and testing play a crucial role in identifying asymptomatic infections, serving as essential tools alongside robust sexual health promotion strategies from public health officials. Furthermore, molecular diagnostics are vital for implementing resistance-guided therapies, especially given the rising mutation rates in STIs. Early detection through effective diagnostics not only aids in timely treatment but also helps combat the growing challenge of antimicrobial resistance.

Given the many unknowns of STIs, experts also called for regional and coordinated global antimicrobial resistance surveillance efforts, citing the need for close monitoring of cases as effective treatments are far and few between.

Additional resources: 

[1] Improving access and patient outcomes for sexually transmitted infections in the US

[2] Rapid point of care (POC) testing for STIs: Advancing care and improving clinical workflow

References:

[1] Kenyon, C. et al. (2019) ‘Population-level antimicrobial consumption is associated with decreased antimicrobial susceptibility in neisseria gonorrhoeae in 24 European countries: An ecological analysis’, The Journal of Infectious Diseases [Preprint]. doi:10.1093/infdis/jiz153.