Frequency of bacterial STI testing amongst people accessing sexual health services in England, 2024: a cross-sectional analysis of national surveillance data

This 2024 cross-sectional analysis of national surveillance data reveals that while the majority of people accessing sexual health services in England tested only once, frequent quarterly testing remains low even among high-risk groups like GBMSM and PrEP users, highlighting a critical gap between current testing recommendations and actual practice.

The Gist

Imagine the national sexual health system in England as a massive, bustling health checkpoint where people stop to check if they have any invisible "bugs" (bacteria) that could cause trouble later. This study is like taking a snapshot of everyone who stopped at this checkpoint in 2024 to see how often they were getting checked.

Here is the story of what they found, broken down into simple concepts:

1. The "One-and-Done" Crowd vs. The "Regulars"

Think of the people visiting these health services as customers at a gym.

• The Casual Visitors (80%): Most people (about 4 out of 5) came in, got a full check-up for the four main "bugs" (Chlamydia, Gonorrhoea, Syphilis, and HIV), and then left. They treated it like a one-time car service.
• The Regulars (Only 2%): A very small group came back at least four times a year (every three months). These are the people who treat their health like a subscription service, checking in regularly no matter what.

2. Who Are the "Regulars"?

If you looked at the list of people who came back four times a year, you'd see a specific pattern. It's like a VIP club with a very specific dress code. The "Regulars" were mostly:

• Gay and bisexual men (and other men who have sex with men).
• People living in London (the big city hub).
• People using HIV prevention pills (PrEP).
• People with many partners (5 or more in just three months).

Even within this "VIP club," the numbers were surprisingly low. For example, even among gay and bisexual men who admitted to having high-risk behaviors, only about 1 in 10 were actually coming in for those recommended quarterly checks. It's like a coach telling a player, "You need to train every week," but the player only shows up once a month.

3. The Big Problem: The "Safety Net" Has Holes

The study highlights a gap between the rules and the reality.

• The Rule: Doctors and guidelines say, "If you are high-risk, you should get checked every three months."
• The Reality: Most high-risk people are only getting checked once a year (or less).

Imagine you have a leaky roof. The advice is to check it every month during the rainy season. But most people only check it once a year, right before winter starts. By the time they check, the damage might already be done.

4. Why Does This Matter?

The researchers are sounding an alarm bell for two reasons:

1. Missed Infections: If high-risk people aren't checking in often enough, they might carry infections without knowing it, potentially passing them to others.
2. The Antibiotic Dilemma: There is a debate happening in the medical world. On one hand, we need to find and treat infections to stop them spreading. On the other hand, if we test everyone too aggressively (even when they have no symptoms), we might use too many antibiotics, which could make the bacteria "super-strong" and harder to kill later (antibiotic resistance).

The Bottom Line

This study is a reality check. It tells us that while most people are doing something by visiting the clinic, the people who are at the highest risk of catching or spreading these infections are not checking in nearly often enough.

To fix this, health officials need to stop guessing and start targeting their messages. They need to figure out how to get those "high-risk" groups to become "regulars" at the health checkpoint, ensuring the safety net is tight where it matters most.

Technical Summary

Based on the provided abstract and supplementary sections, here is a detailed technical summary of the study:

Study Overview

Title: Frequency of bacterial STI testing amongst people accessing sexual health services in England, 2024: a cross-sectional analysis of national surveillance data.

1. Problem Statement

While testing and treatment remain central pillars of Sexually Transmitted Infection (STI) prevention, there is a significant gap in national-level evidence regarding the actual frequency of STI testing within Sexual Health Services (SHS) in England. Recent discourse has questioned the effectiveness of asymptomatic testing for chlamydia and gonorrhoea in Gay, Bisexual, and other Men who have Sex with Men (GBMSM), citing concerns over rising antimicrobial resistance and individual harm. However, without granular data on testing frequency across different demographics and risk groups, it is difficult to evaluate whether current testing guidelines are being adhered to or to optimize screening strategies.

2. Methodology

• Study Design: Cross-sectional analysis of national surveillance data.
• Data Source: The GUMCAD (Genitourinary Medicine Clinic Activity Dataset) STI surveillance system.
• Population: Individuals accessing face-to-face and online Sexual Health Services (SHS) in England during the year 2024.
• Scope of Analysis: The study focused on attendances involving tests for four key bacterial STIs: chlamydia, gonorrhoea, syphilis, and HIV.
• Variables Analyzed:
  • Testing Frequency: Quantified by the number of tests completed per individual in 2024 (e.g., single test vs. quarterly/4+ tests).
  • Testing Combinations: Patterns of testing (e.g., single pathogen test vs. full STI screen).
  • Stratification: Data was disaggregated by sociodemographic characteristics, behavioral risk factors, clinical setting (face-to-face vs. online), and test outcomes (positivity).

3. Key Contributions

This study provides the first comprehensive, national-level quantification of STI testing frequency in England for 2024. It moves beyond aggregate attendance numbers to analyze the behavioral patterns of testing (i.e., how often individuals return for testing). Crucially, it identifies the disparity between recommended testing guidelines (specifically quarterly testing for high-risk groups) and actual clinical practice.

4. Key Results

• Volume and Scope: There were 2,222,028 attendances at SHS in England in 2024 involving tests for the four target STIs. The majority of these attendances involved comprehensive screening for all four pathogens.
• Testing Frequency Distribution:
  • Single Testing: The vast majority of attendees (80.1%) tested only once during the year.
  • Frequent Testing: Only a small minority (1.9%) tested at least quarterly (4 or more times).
• Demographic and Behavioral Variations:
  • GBMSM: While they had a higher proportion of quarterly testers (6.7%) compared to the general population, this still represents a low adherence rate.
  • HIV-PrEP Users: This group showed the highest frequency of quarterly testing at 13%.
  • High-Risk Behaviors: Individuals reporting 5+ partners in the previous 3 months had a 10.6% quarterly testing rate.
  • Geography and Setting: London residents (3.6%) and online testers (2.5%) showed higher frequencies than the national average.
• Guideline Adherence Gap: A critical finding is that only 10.5% of GBMSM reporting higher-risk sexual behaviors tested quarterly, despite national guidelines recommending this frequency for this specific group.

5. Significance and Implications

• Policy and Guidelines: The data suggests that current testing recommendations are not being met by the target high-risk populations. The low frequency of testing (even among those theoretically most likely to test frequently, such as PrEP users) challenges the assumption that high-risk groups are engaging in regular screening.
• Antimicrobial Resistance (AMR): The findings provide context for the debate on asymptomatic screening. Since the majority of testing is "one-off" rather than frequent, the volume of testing driving AMR may be lower than feared, but the missed opportunities for early detection in high-risk groups are significant.
• Intervention Strategy: Public health interventions must be tailored to specific groups. The study highlights that "high-risk" behavior does not automatically correlate with "high-frequency" testing. Future messaging and interventions need to address the barriers preventing high-risk individuals (particularly GBMSM and PrEP users) from accessing quarterly testing.
• Research Direction: The study underscores the need for further research into why behaviorally high-risk individuals are not testing frequently, which is essential for updating STI screening guidelines and optimizing resource allocation in sexual health services.