UG1 How well are online sexually transmitted infection treatment providers doing? Measuring the performance of online treatment providers against BASHH national guidelines

Abstract

Introduction

Online pharmacies are an easily accessible method of procuring treatments for Sexually Transmitted Infections (STIs). We aimed to determine whether treatments sold by online pharmacies in the United Kingdom adhere to national guidelines set by the British Association for Sexual Health and HIV (BASHH) with respect to treatment.

Methods

Using findings from a previous similar study (2017) and Google search engine results (October 2022), a list of pharmacies offering treatments for Herpes simplex Virus (HSV), Chlamydia trachomatis (CT), Neisseria gonorrhoeae (NG), Trichomonas vaginalis (TV), Non-gonococcal urethritis (NGU) and Mycoplasma genitalium (Mgen), was compiled. Treatments offered were recorded and compared to BASHH guidelines.

Results

24 pharmacies were identified, two of which were excluded. All but one (95%) of the pharmacies required completion of an online consultation form before treatment could be bought. The one not requiring a consultation offered treatment for CT, HSV and MG. Despite 17 pharmacies (77.7%) asking if the individual had been diagnosed with a particular STI, submission of proof of diagnosis was only required by one (4.2%). All pharmacies included written information about the infections for which they offered treatment, although this was of variable quality. Partner notification, as well as partner testing, was recommended by many pharmacies, but guideline adherence was variable within- and between-pharmacies.

Discussion

Compared with the 2017 study, a similar number of online pharmacies is available. Apparent improvements in practice were observed for CT from 88% of pharmacies in 2017 to 100% of pharmacies in our study complying with BASHH guidelines, but numbers are too small for statistical comparison. Poor online prescribing practice for NG, likely because first-line treatment requires an intramuscular injection, is a concern. The non-requirement for proof of diagnosis is problematic and threatens antibiotic stewardship principles. National regulation of, and direct communication with, online pharmacies may help reduce discrepancies with national treatment recommendations.