Materials chemistry-enabled platforms in detecting sexually transmitted infections: progress towards point-of-care tests

Vulvovaginitis is a common complaint in adolescents. There are specific and nonspecific causes. Specific causes include sexually transmitted infections and so it is important to take a sexual history in any adolescent presenting with vulvovaginal complaints. A sexual history should be taken in a sensitive and confidential manner. Diagnosis of vulvovaginitis requires an external genital examination and may require a pelvic examination based on other presenting symptoms. Microscopy is typically used to make a diagnosis. More sensitive or specific point of care tests are commercially available, but they can be cost prohibitive. Treatment of vulvovaginitis is based on underlying pathology and often a review of vaginal hygiene may be necessary.In special patient populations, extended or repeat treatment may be necessary. This review contains 3 figures, 2 tables, and 21 references. Key Words: adolescent, bacterial vaginosis, candidiasis, confidentiality, discharge, dysuria, sexually transmitted infections (STIs), trichomonas, vaginitis, wet prep

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Modelling-based evaluation of the costs, benefits and cost-effectiveness of multipathogen point-of-care tests for sexually transmitted infections in symptomatic genitourinary medicine clinic attendees

BMJ Open ◽

10.1136/bmjopen-2017-020394 ◽

2018 ◽

Vol 8 (9) ◽

pp. e020394 ◽

Cited By ~ 10

Author(s):

Susie E Huntington ◽

Richéal M Burns ◽

Emma Harding-Esch ◽

Michael J Harvey ◽

Rachel Hill-Tout ◽

...

Keyword(s):

Cost Effectiveness ◽

Sexually Transmitted Infections ◽

Point Of Care ◽

Secondary Outcome ◽

Annual Number ◽

Base Case ◽

Sexually Transmitted ◽

Life Years ◽

Genitourinary Medicine ◽

Point Of Care Tests

ObjectivesTo quantify the costs, benefits and cost-effectiveness of three multipathogen point-of-care (POC) testing strategies for detecting common sexually transmitted infections (STIs) compared with standard laboratory testing.DesignModelling study.SettingGenitourinary medicine (GUM) services in England.PopulationA hypothetical cohort of 965 988 people, representing the annual number attending GUM services symptomatic of lower genitourinary tract infection.InterventionsThe decision tree model considered costs and reimbursement to GUM services associated with diagnosing and managing STIs. Three strategies using hypothetical point-of-care tests (POCTs) were compared with standard care (SC) using laboratory-based testing. The strategies were: A) dual POCT forChlamydia trachomatis(CT) andNeisseria gonorrhoeae(NG); B) triplex POCT for CT-NG andMycoplasma genitalium(MG); C) quadruplex POCT for CT-NG-MG andTrichomonas vaginalis(TV). Data came from published literature and unpublished estimates.Primary and secondary outcome measuresPrimary outcomes were total costs and benefits (quality-adjusted life years (QALYs)) for each strategy (2016 GB, £) and associated incremental cost-effectiveness ratios (ICERs) between each of the POC strategies and SC. Secondary outcomes were inappropriate treatment of STIs, onward STI transmission, pelvic inflammatory disease in women, time to cure and total attendances.ResultsIn the base-case analysis, POC strategy C, a quadruplex POCT, was the most cost-effective relative to the other strategies, with an ICER of £36 585 per QALY gained compared with SC when using microcosting, and cost-savings of £26 451 382 when using tariff costing. POC strategy C also generated the most benefits, with 240 467 fewer clinic attendances, 808 fewer onward STI transmissions and 235 135 averted inappropriate treatments compared with SC.ConclusionsMany benefits can be achieved by using multipathogen POCTs to improve STI diagnosis and management. Further evidence is needed on the underlying prevalence of STIs and SC delivery in the UK to reduce uncertainty in economic analyses.

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