NIHR DC Discover

NIHR Signal Men find self-testing acceptable to test for sexually transmitted infections

Published on 28 March 2017

doi: 10.3310/signal-000402

Sexually transmitted infections (STIs) are common and treatable but men are more reluctant than women to have a test. Self-testing is known to be accurate, but can men use this more?

Most men aged 18-35 would be willing to collect and send off a urine sample using a kit to test for STIs, according to a national survey. GP surgeries were the most popular place to collect kits, followed by pharmacies and sexual health clinics.

Other venues might be useful extra places to distribute testing kits and increase their use. About half of young men play football, and half of them are willing to collect kits from the club they play at. Extra advice from a health advisor or team captain does not seem to increase the use of these tests. However, none of the 90 men tested in this study had an infection, so football clubs may not be the best place to find men with undetected STIs.

Share your views on the research.

Why was this study needed?

Chlamydia is the most common STI in England, with untreated chlamydia infection costing the NHS more than £100 million every year.

In 2015, over 1.5 million chlamydia tests were carried out. However, uptake of chlamydia testing is lower in men than in women, despite rates of infection being similar in both genders. Promoting testing in non-healthcare venues, such as sports clubs, and offering self-testing kits might improve rates in men.

In people who test positive for chlamydia, providing quick access to treatment and notifying their sexual partners can reduce the spread of infection. Genitourinary medicine clinics, which are where just under half of young people in England with chlamydia are diagnosed, offer tracing of sexual partners. However, 58.2% of cases are diagnosed outside these settings, where partner notification services may not be routinely available.

What did this study do?

This survey and the SPORTSMART pilot randomised controlled trials aimed to improve uptake of STI testing in men. They were part of a larger programme of research funded by NIHR.

The survey asked 411 men aged 18-35 years about their sexual activity and which venues they would collect STI tests from.

The pilot trial compared three ways of promoting STI opportunistic testing in six amateur football clubs in London. Two clubs received a promotional talk on STIs and self-testing kits during the pre- or post-match briefing. One club had the talk from a captain, and the other club from a healthcare professional. The third group had only posters, with kits available on request.

What did it find?

  • The survey found that the majority (85%) of men were willing to test themselves for STIs. General practices (80%), sexual health clinics (67%) and pharmacies (65%) were the most acceptable places for men to pick up a self-testing kit. Smaller proportions thought sporting venues, such as gyms (19%) and sports centres (13%), were acceptable pick-up points, although this rose to 54% among men who did sport regularly.
  • In the football club trial, about half of men accepted the offer of STI opportunistic screening: 50% of the football captain group, 67% of the healthcare professional group and 61% of poster only group, with no significant difference found.
  • Ninety men completed the tests altogether and none tested positive for STIs.

What does current guidance say on this issue?

NICE guidance on preventing sexually transmitted infections (2007) recommends holding one-to-one structured discussions with people at high risk of STIs. People with an STI should be helped to get their partners tested and treated, when necessary.

Public Health England advise that local sexual health services undertake opportunistic screening of young adults who are sexually active and without symptoms. They suggest this is done annually or on change of partner, in a variety of settings and that local authorities should work towards a rate of at least 2,300 chlamydia diagnoses per 100,000 population aged 15 to 24 years.

The British Association for Sexual Health and HIV statement on partner notification for sexually transmissible infections (2012) recommends that people with chlamydia should be offered at least one discussion (face-to-face or telephone) to begin the partner notification process. A plan should be agreed with the infected person about who to contact and how.

What are the implications?

These studies indicate that providing easy access to STI self-testing kits in various venues may increase uptake among men.

Previous studies have suggested that men may be open to collecting STI tests in non-healthcare settings, in particular sports venues. This study suggests that promoting STI testing in sports venues may increase their use, though few cases may be found.

Healthcare settings are still valued pick-up points and GP surgeries may be the most useful.

Citation and Funding

Estcourt C, Sutcliffe L, Mercer CH, et al. The Ballseye programme: a mixed-methods programme of research in traditional sexual health and alternative community settings to improve the sexual health of men in the UK. Programme Grants for Applied Research. 2016;(4)20.

This study was funded by the National Institute for Health Research Programme Grants for Applied Research (project number RP-PG-0707-10208).

Bibliography

British Association for Sexual Health and HIV. Statement on partner notification for sexually transmissible infections. Macclesfield: British Association for Sexual Health and HIV; 2012.

NHS Choices. Chlamydia. London: Department of Health; 2015.

NHS Choices. Sexually transmitted infections (STIs). London: Department of Health; 2015.

NICE. Sexually transmitted infections and under-18 conceptions: prevention. PH3. London: National Institute for Health and Care Excellence; 2007.

Public Health England. Leaders’ Briefing: Opportunistic Chlamydia Screening of Young Adults in England. PHE publications gateway number 2014018; 2014.

Why was this study needed?

Chlamydia is the most common STI in England, with untreated chlamydia infection costing the NHS more than £100 million every year.

In 2015, over 1.5 million chlamydia tests were carried out. However, uptake of chlamydia testing is lower in men than in women, despite rates of infection being similar in both genders. Promoting testing in non-healthcare venues, such as sports clubs, and offering self-testing kits might improve rates in men.

In people who test positive for chlamydia, providing quick access to treatment and notifying their sexual partners can reduce the spread of infection. Genitourinary medicine clinics, which are where just under half of young people in England with chlamydia are diagnosed, offer tracing of sexual partners. However, 58.2% of cases are diagnosed outside these settings, where partner notification services may not be routinely available.

What did this study do?

This survey and the SPORTSMART pilot randomised controlled trials aimed to improve uptake of STI testing in men. They were part of a larger programme of research funded by NIHR.

The survey asked 411 men aged 18-35 years about their sexual activity and which venues they would collect STI tests from.

The pilot trial compared three ways of promoting STI opportunistic testing in six amateur football clubs in London. Two clubs received a promotional talk on STIs and self-testing kits during the pre- or post-match briefing. One club had the talk from a captain, and the other club from a healthcare professional. The third group had only posters, with kits available on request.

What did it find?

  • The survey found that the majority (85%) of men were willing to test themselves for STIs. General practices (80%), sexual health clinics (67%) and pharmacies (65%) were the most acceptable places for men to pick up a self-testing kit. Smaller proportions thought sporting venues, such as gyms (19%) and sports centres (13%), were acceptable pick-up points, although this rose to 54% among men who did sport regularly.
  • In the football club trial, about half of men accepted the offer of STI opportunistic screening: 50% of the football captain group, 67% of the healthcare professional group and 61% of poster only group, with no significant difference found.
  • Ninety men completed the tests altogether and none tested positive for STIs.

What does current guidance say on this issue?

NICE guidance on preventing sexually transmitted infections (2007) recommends holding one-to-one structured discussions with people at high risk of STIs. People with an STI should be helped to get their partners tested and treated, when necessary.

Public Health England advise that local sexual health services undertake opportunistic screening of young adults who are sexually active and without symptoms. They suggest this is done annually or on change of partner, in a variety of settings and that local authorities should work towards a rate of at least 2,300 chlamydia diagnoses per 100,000 population aged 15 to 24 years.

The British Association for Sexual Health and HIV statement on partner notification for sexually transmissible infections (2012) recommends that people with chlamydia should be offered at least one discussion (face-to-face or telephone) to begin the partner notification process. A plan should be agreed with the infected person about who to contact and how.

What are the implications?

These studies indicate that providing easy access to STI self-testing kits in various venues may increase uptake among men.

Previous studies have suggested that men may be open to collecting STI tests in non-healthcare settings, in particular sports venues. This study suggests that promoting STI testing in sports venues may increase their use, though few cases may be found.

Healthcare settings are still valued pick-up points and GP surgeries may be the most useful.

Citation and Funding

Estcourt C, Sutcliffe L, Mercer CH, et al. The Ballseye programme: a mixed-methods programme of research in traditional sexual health and alternative community settings to improve the sexual health of men in the UK. Programme Grants for Applied Research. 2016;(4)20.

This study was funded by the National Institute for Health Research Programme Grants for Applied Research (project number RP-PG-0707-10208).

Bibliography

British Association for Sexual Health and HIV. Statement on partner notification for sexually transmissible infections. Macclesfield: British Association for Sexual Health and HIV; 2012.

NHS Choices. Chlamydia. London: Department of Health; 2015.

NHS Choices. Sexually transmitted infections (STIs). London: Department of Health; 2015.

NICE. Sexually transmitted infections and under-18 conceptions: prevention. PH3. London: National Institute for Health and Care Excellence; 2007.

Public Health England. Leaders’ Briefing: Opportunistic Chlamydia Screening of Young Adults in England. PHE publications gateway number 2014018; 2014.

The Ballseye programme: a mixed-methods programme of research in traditional sexual health and alternative community settings to improve the sexual health of men in the UK

Published on 16 December 2016

Estcourt C, Sutcliffe L, Mercer CH, Copas A, Saunders J, Roberts TE

Programme Grants for Applied Research Volume 4 Issue 20 , 2016

Background Sexually transmitted infection (STI) diagnoses are increasing and efforts to reduce transmission have failed. There are major uncertainties in the evidence base surrounding the delivery of STI care for men. Aim To improve the sexual health of young men in the UK by determining optimal strategies for STI testing and care Objectives To develop an evidence-based clinical algorithm for STI testing in asymptomatic men; model mathematically the epidemiological and economic impact of removing microscopy from routine STI testing in asymptomatic men; conduct a pilot randomised controlled trial (RCT) of accelerated partner therapy (APT; new models of partner notification to rapidly treat male sex partners of people with STIs) in primary care; explore the acceptability of diverse venues for STI screening in men; and determine optimal models for the delivery of screening. Design Systematic review of the clinical consequences of asymptomatic non-chlamydial, non-gonococcal urethritis (NCNGU); case–control study of factors associated with NCNGU; mathematical modelling of the epidemiological and economic impact of removing microscopy from asymptomatic screening and cost-effectiveness analysis; pilot RCT of APT for male sex partners of women diagnosed with Chlamydia trachomatis infection in primary care; stratified random probability sample survey of UK young men; qualitative study of men’s views on accessing STI testing; SPORTSMART pilot cluster RCT of two STI screening interventions in amateur football clubs; and anonymous questionnaire survey of STI risk and previous testing behaviour in men in football clubs. Settings General population, genitourinary medicine clinic attenders, general practice and community contraception and sexual health clinic attenders and amateur football clubs. Participants Men and women. Interventions Partner notification interventions: APTHotline [telephone assessment of partner(s)] and APTPharmacy [community pharmacist assessment of partner(s)]. SPORTSMART interventions: football captain-led and health adviser-led promotion of urine-based STI screening. Main outcome measures For the APT pilot RCT, the primary outcome, determined for each contactable partner, was whether or not they were considered to have been treated within 6 weeks of index diagnosis. For the SPORTSMART pilot RCT, the primary outcome was the proportion of eligible men accepting screening. Results Non-chlamydial, non-gonococcal urethritis is not associated with significant clinical consequences for men or their sexual partners but study quality is poor (systematic review). Men with symptomatic and asymptomatic NCNGU and healthy men share similar demographic, behavioural and clinical variables (case–control study). Removal of urethral microscopy from routine asymptomatic screening is likely to lead to a small rise in pelvic inflammatory disease (PID) but could save > £5M over 20 years (mathematical modelling and health economics analysis). In the APT pilot RCT the proportion of partners treated by the APTHotline [39/111 (35%)], APTPharmacy [46/100 (46%)] and standard patient referral [46/102 (45%)] did not meet national standards but exceeded previously reported outcomes in community settings. Men’s reported willingness to access self-sampling kits for STIs and human immunodeficiency virus infection was high. Traditional health-care settings were preferred but sports venues were acceptable to half of men who played sport (random probability sample survey). Men appear to prefer a ‘straightforward’ approach to STI screening, accessible as part of their daily activities (qualitative study). Uptake of STI screening in the SPORTSMART RCT was high, irrespective of arm [captain led 28/56 (50%); health-care professional led 31/46 (67%); poster only 31/51 (61%)], and costs were similar. Men were at risk of STIs but previous testing was common. Conclusions Men find traditional health-care settings the most acceptable places to access STI screening. Self-sampling kits in football clubs could widen access to screening and offer a public health impact for men with limited local sexual health services. Available evidence does not support an association between asymptomatic NCNGU and significant adverse clinical outcomes for men or their sexual partners but the literature is of poor quality. Similarities in characteristics of men with and without NCNGU precluded development of a meaningful clinical algorithm to guide STI testing in asymptomatic men. The mathematical modelling and cost-effectiveness analysis of removing all asymptomatic urethral microscopy screening suggests that this would result in a small rise in adverse outcomes such as PID but that it would be highly cost-effective. APT appears to improve outcomes of partner notification in community settings but outcomes still fail to meet national standards. Priorities for future work include improving understanding of men’s collective behaviours and how these can be harnessed to improve health outcomes; exploring barriers to and facilitators of opportunistic STI screening for men attending general practice, with development of evidence-based interventions to increase the offer and uptake of screening; further development of APT for community settings; and studies to improve knowledge of factors specific to screening men who have sex with men (MSM) and, in particular, how, with the different epidemiology of STIs in MSM and the current narrow focus on chlamydia, this could negatively impact MSM’s sexual health. Funding The National Institute for Health Research Programme Grants for Applied Research programme.

Expert commentary

Up until recently, it was common practice in sexual health clinics to take a swab from the penis to look for evidence of an STI, even in men with no symptoms. Not surprisingly, this is not popular with men and might be a barrier to getting an STI test. This study shows that ‘remote STI screening’, in which an asymptomatic man can take their own sample (usually urine), send it in to the laboratory by post and receive their results by text message, is highly acceptable especially when testing kits are available from primary care, sexual health clinics or pharmacies.

Jonathan Ross, Professor of Sexual Health and HIV, University Hospitals Birmingham NHS Foundation Trust

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