Bacterial Sexually Transmitted Disease Screening Outside the Clinic—Implications for the Modern Sexually Transmitted Disease Program

Abstract

Background The development of noninvasive nucleic acid amplification tests for chlamydia and gonorrhea has facilitated innovation in moving sexually transmitted disease (STD) screening to nonclinical settings. However, limited data are available to inform local STD programs on evidence-based approaches to STD screening in nonclinical settings in the United States. Methods We conducted a systematic review of the literature published since 2000 related to chlamydia, gonorrhea, and syphilis screening in US correctional settings, bathhouses and sex venues, self-collected at-home testing, and other nonclinical sites. Results Sixty-four articles met eligibility criteria and were reviewed. Although data on testing volume and positivity were available, there were scarce data on the proportion of new positives treated and the programmatic costs for the various screening programs. Screening in correctional settings identified a sizable amount of asymptomatic infections. The value and sustainability of screening in the other nonclinical settings examined was not clear from the published literature. Conclusions Local and state health departments should explore the development of sustainable jail and juvenile detention screening programs for STDs. Furthermore, local programs should pilot outreach and home-based STD screening programs to determine if they are identifying asymptomatic persons who would not have otherwise been found. Local programs are encouraged to present and publish their findings related to non–clinic-based screening to enhance the limited body of literature; data on the proportion of new infections treated and the local program costs are needed.

Social Vulnerability in Congenital Syphilis Case Mothers: Qualitative Assessment of Cases in Indiana, 2014 to 2016

“…STD screening in correctional settings, for example, has been shown to be effective in identifying persons with undiagnosed bacterial STDs. 29 …”

Self-collection of samples as an additional approach to deliver testing services for sexually transmitted infections: a systematic review and meta-analysis

“…Because this study was designed to inform WHO guidelines on the viability of self-sampling as an additional means to increase testing, articles that compared self-collection of samples by the location of intervention delivery (ie, self-collection at home vs self-collection at the clinic) were not included. These articles have been reviewed elsewhere 19 26–31…”

“…Self-collection approaches also have the potential to address some common barriers to clinician-dependent and/or clinic-based diagnosis, such as concerns around autonomy, inconvenience, stigma and lack of privacy 5 24 25. Systematic reviews have been conducted to compare STI testing programmes (some including self-collection methods) in home or non-clinic settings to those in clinic settings 19 26–31. However, no review to date has systematically compared self-collection of samples to clinician-collected methods for STI testing on programmatic outcomes.…”

A Systematic Literature Review of Reviews on the Effectiveness of Chlamydia Testing

“…Major barriers of pharmacy-based screening included having to return the specimen to designated sites and lack of privacy 37,41 for patients and increased workload or feeling uncomfortable when offering the test, and lack of in store advertising for pharmacists 42 . The major benefits for patients included convenience, anonymity and no need for appointment, affordability 36 , shorter waiting times, and friendly non-judgmental attitude of pharmacists 43 . It was concluded that chlamydia screening in community pharmacies were feasible and could be a convenient option 43 .…”

“…The major benefits for patients included convenience, anonymity and no need for appointment, affordability 36 , shorter waiting times, and friendly non-judgmental attitude of pharmacists 43 . It was concluded that chlamydia screening in community pharmacies were feasible and could be a convenient option 43 .…”