What Pharmacists Need to Know About Point-of-Care Testing for STIs

Sexually transmitted infections (STIs) are still on the rise in the United States, even with reduced reporting and testing due to COVID-19. Preliminary 2021 STI surveillance data from the CDC show a combined total of 2.5 million reported cases of syphilis, gonorrhea, and chlamydia.¹

With the continued reduction of the American health care workforce, point-of-care testing (POCT) services in the pharmacy provide patient benefits.² Pharmacists can use POCTs to test and treat patients quickly to improve health outcomes, reduce the burden of disease, and bring down transmission rates. Read on for some best practices for pharmacists looking to successfully implement POCT for STIs.

Be aware of STI prevalence in the community. The most current complete STI surveillance report from 2020 found that 53% of reported cases were among adolescents and young adults aged 15 to 24 years.³ Disparities, the data showed, “continue to persist in rates of reported [STIs] among some racial minority or Hispanic groups when compared with rates among non-Hispanic White persons. In 2020, 32% of all cases of chlamydia, gonorrhea, and P&S [primary and secondary] syphilis were among non-Hispanic Black persons, even though they made up only approximately 12% of the US population,” the CDC reported.³ Importantly, the CDC stressed that this was not due to difference in sexual behavior, but instead caused by inequities in access to sexual health care and higher risk due to the high prevalence in certain communities.³

Regardless of race, men who have sex with men are another group at high risk for STIs.³ Pharmacists who are aware of these higher-risk groups can proactively screen individuals and provide appropriate treatment recommendations.

Become familiar with available POCTs for STIs. Newer POCTs include nucleic acid amplification tests (NAATs), which detect the genetic material of the pathogen. These are the CDC-recommended tests and they are FDA approved for chlamydia and gonorrhea.4 There are also non–NAAT tests that detect antigens.⁴

Pharmacists must understand the sensitivity and specificity of each test to ensure accurate diagnosis and treatment. A review of current POCT tests has been published in the journal Sexually Transmitted Infections.⁴ Pharmacists should also understand the potential for false-negative or false-positive results and how to respond accordingly.

Consider the laws, regulations, privacy standards, and ethics around STI POCT in the pharmacy. In some states, pharmacists are not allowed to perform POCT without a prescription or collaborative practice agreement with a physician. The Health Insurance Portability and Accountability Act and other privacy laws require pharmacists to protect patients’ confidentiality and ensure that their test results are not shared without their consent, which can become complicated in cases where minors receive testing, and laws vary by state.⁵ Pharmacists must be familiar with these laws and regulations to ensure compliance and protect patients’ rights.⁶

Educate patients about the importance of STI testing and treatment. Patients may be reluctant to discuss their sexual history or symptoms.⁷ They may feel embarrassed or stigmatized by the testing process.⁷ Pharmacists can address these concerns by creating a welcoming and nonjudgmental environment. “If your patient is hesitant to answer a question, try rephrasing it or briefly explain why you are asking it. Ensure that you and your patient share an understanding of the terms being used to avoid confusion,” the CDC noted.⁷

Pharmacists should provide clear and concise information about the testing process and emphasize the importance of early diagnosis and treatment for STIs. The CDC offers providers assistance in discussing STIs, testing, treatment, and partner notification in its #TalkTestTreat tool kit for providers.⁷

Consider the potential for adverse reactions or interactions between POCT and other medications or medical conditions. Some STI treatments may interact with other medications or medical conditions, such as liver or kidney disease.⁸ Pharmacists can refer to the CDC’s Sexually Transmitted Infections Treatment Guidelines,⁸ published in 2021, for full treatment information and in-depth information about adverse treatment outcomes. Pharmacists must be aware of potential interactions and consult with patients’ health care providers as needed to ensure safe and effective treatment.

References

1. Preliminary 2021 STD surveillance data. CDC. Reviewed September 1, 2022. Accessed March 7, 2023. https://www.cdc.gov/std/statistics/2021/ default.htm

2. Fact sheet: strengthening the American healthcare workforce. American Hospital Association. June 2022. Accessed March 7, 2023. https://www.aha.org/fact-sheets/2021-05-26-fact-sheet-strengthening-health-care-workforce

3. Sexually transmitted disease surveillance 2020. Centers for Disease Control and Prevention. Updated April 12, 2022. Accessed March 7, 2023. https://www.cdc.gov/std/statistics/2020/overview.htm

4. Gaydos CA, Manabe YC, Melendez JH. A narrative review of where we are with point-of-care sexually transmitted infection testing in the United States. Sex Transm Dis. 2021;48(8S):S71-S77. doi:10.1097/ OLQ.0000000000001457

5. Wisk LE, Gray SH, Gooding HC. I thought you said this was confidential?- challenges to protecting privacy for teens and young adults. JAMA Pediatr. 2018;172(3):209-210. doi:10.1001/jamapediatrics.2017.3927

6. Adamson PC, Loeffelholz MJ, Klausner JD. Point-of-care testing for sexually transmitted infections: a review of recent developments. Arch Pathol Lab Med. 2020;144(11):1344-1351. doi:10.5858/arpa.2020- 0118-RA

7. STI awareness week: providers #TalkTestTreat. Centers for Disease Control and Prevention. Updated February 15, 2023. Accessed March 7, 2023. https://www.cdc.gov/std/saw/talktesttreat/providers.htm

8. Workowski KA, Bachman LH, Chan PA, et al. Sexually transmitted infections treatment guidelines, 2021. MMWR Recomm Rep. 2021;70(4):1- 187. doi:10/15595/mmwr.rr7004a1