Current Data to Inform Point-of-Care Testing for Sexually Transmitted Infections in United States Healthcare Settings: A Narrative Review.

Abstract

Point-of-care testing (POCT) for sexually transmitted infections (STIs) holds promise to improve care across clinical settings in the United States (US). However, multiple barriers to widespread adoption remain, and universal use will not be appropriate. At a minimum, decision-makers require robust, real-world evidence that STI POCTs improve patient outcomes within specific clinical contexts for these tests to be reimbursed and adopted, and data among priority patient groups may help guide targeted utilization. To inform decisions in the US and identify gaps in the evidence base, we reviewed literature on impact of STI POCTs for gonorrhea (NG), chlamydia (CT), trichomoniasis and syphilis on clinical outcomes across emergency departments (EDs), STI/sexual health clinics, primary care and gynecology clinics, and urgent care centers. Because US outcome data are sparse in several settings, we included studies from other high-income regions (Europe, Australia and Canada) noting where findings may not generalize to US practice. Evidence was summarized for priority patient groups (including symptomatic individuals and STI contacts), stratified by sex. We found some evidence for improved outcomes, particularly for symptomatic women in the ED. However, most studies did not stratify results by priority population, and the majority examined ≥90-minute CT/NG tests which, especially outside the ED, returned results only after the visit. Additional research is needed on the impact of STI POCTs on clinical outcomes in priority populations (including ≤30-minute tests), on workflow strategies enabling actionable results before the end of the encounter, and to provide updated cost or cost-effectiveness analyses across US clinical settings.