Contributed Commentary by David Fraser
October 18, 2018 | Last year, almost half a million cases of sexually transmitted infections (STIs) were recorded in England and Wales, while clinic attendances rose by 13%.
The rise in the number of recorded cases of STIs is rapidly becoming a global trend. In the United States, the Centers for Disease Control and Prevention (CDC) recorded 1.6 million cases of chlamydia in 2017.
According to a new report published by Public Health England (PHE), the most common diagnosis was chlamydia, with over 126,000 recorded cases of the disease. This was followed by a 22% increase in the number of diagnoses of gonorrhea, which surged to 44,676. Reported diagnoses of syphilis also rose to 7,137 cases – a 20% increase from 2016.
Aside from early symptoms that many STIs can cause — such as painful urination, discharge, bleeding, swelling or pain — long-term symptoms in people who don't receive treatment can be serious. STIs also have downstream consequences for the next generation.
Cases of congenital syphilis, which can cause severe illness and stillbirth, has increased in new-borns 38% from 2012 to 2014, according to the CDC, although women don't even represent 10% of new infections overall.
New, more challenging STIs are becoming more prevalent, adding another area of concern for health organizations.
Mycoplasma Genitalium (MG), for example, is a rare sexually transmitted infection that doctors are warning is in danger of becoming a superbug. First discovered in 1981, MG is currently thought to affect around one in 100 adults aged 16 to 44 in the UK, with the majority showing no symptoms. However, despite this, many sexual health clinics lack the tools to diagnose it properly.
MG can carry similar symptoms to chlamydia and as a result is often misdiagnosed, meaning that it is quickly becoming resistant to treatment. This confusion and lack of test kits mean it is being treated with incorrect drug doses - building up antibiotic resistance which could eventually leave the disease untreatable.
With these dangerous infections becoming more widespread, new diagnostic approaches are needed to halt the burgeoning epidemic.
The British Association of Sexual Health and HIV (BASHH) has recently launched new guidelines on how to diagnose MG and recommends patients take a nucleic acid amplification test, which is carried out by swab or a urine sample.
Providing a more targeted and accurate diagnosis of STIs through self-testing could lead to quicker diagnosis for patients, enabling people to gain greater control of their sexual health. Self-testing technology, such as a lateral flow diagnostic test, could help to ensure that common STIs such as chlamydia, gonorrhea, syphilis, and trichomoniasis can be accurately diagnosed by patients without requiring professional support.
Self-diagnosis carries multiple benefits for both patients and healthcare professionals, including convenience, anonymity, and not requiring physical examination. Using smartphone test readers and custom apps, developed by diagnostic specialists, would provide patients with guided step-by-step instructions, removing the ambiguity of reading strips.
Smartphone apps supporting self-diagnosis would enable the user to read and share the results of their diagnostic test with a healthcare professional – creating a pool of data that can provide a deeper understanding of geographical hot spots where sexual diseases such as MG are spreading.
Facilitating a self-test could also increase diagnosis among people who could not otherwise come forward for testing, possibly out of fear of the high levels of stigma associated with some STIs. Social misconceptions around the cause and treatment of sexually transmitted diseases remains a pervasive barrier to early detection, with many young people preferring to delay testing rather than being faced with the anxiety of a positive result.
Developing an easy to use, sensitive, over the counter (OTC) diagnostic for STIs, supported with an app-based reader with guided instructions to allow for easier self-testing, would herald a new approach to targeting sexually transmitted infections.
Self-testing could hold the potential to address the worldwide rise in STIs, hopefully leading to earlier diagnosis and providing a supportive and connected treatment plan for patients.
David Fraser is the Lateral Flow Product Manager at BBI Solutions. Within this role it is his responsibility to be an internal and external champion of BBI Solutions’ Lateral Flow products and services, to understand the market and ensure that the suite of services BBI Solutions offers meets their customers’ needs. He can be reached at davidfraser@bbisolutions.com.