Adrian Kelly (SHL) Mark Clune (Preventx)
In response to the Covid-19 pandemic, online testing services (e-SHS) have increased to allow asymptomatic individuals to test for sexually transmitted infections (STIs). Individuals with mild symptoms were newly able to use e-SHS to test, while those with complex symptoms were referred to clinics.
This study looks at the demographics of mildly symptomatic and asymptomatic groups, to determine if individuals most at risk for sexual health inequalities access symptomatic testing.
Retrospective analysis was performed on 596,637 orders, by users who were asymptomatic (n=484,139) and mild symptomatic (n=112,498), placed between 26 March 2020 and 30 June 2021.
We examined sex, ethnicity, deprivation decile, and age of individuals placing test kit orders in the symptomatic and asymptotic cohorts, exploring the difference in the proportions of demographics between the cohorts.
We found a higher proportion of symptomatic to asymptomatic users in testing kit orders from deprived areas (deciles 1, 2 and 3) compared with affluent areas.
There was a higher proportion of symptomatic females testing (74.4% [83,731/112,498]), compared to the proportion from the asymptomatic cohort (53% [256,491/484,139]). Whereas there was a lower proportion of men in the symptomatic cohort (25.2% [28,311/112,498] of symptomatic orders were from men) compared to the proportion of men in asymptomatic cohort (46.2%, [223,467/484,139]).
With ethnicity, there was a higher proportion of symptomatic Black Caribbean and Black African individuals testing, compared to asymptomatic orders. When looking at age, 10.5% (50990/484,139) of asymptomatic orders were from 18-21-year-olds, whereas they made up 16% (18049/112,498) of orders in the symptomatic cohort.
Over 100,000 people with symptoms accessed online STI tests as a result of the change in service provision. It appears that this symptomatic service is accessible to those demographics associated with the poorest access to sexual health services. More research is needed into the impact of symptomatic STI testing online.