Regulation for online STI testing is urgently needed to ensure all providers are compliant with national guidelines, according to a study published in the BMJ.

An assessment of online self-testing and self-sampling service providers for STIs against national standards in the UK in 2020 found that regulation of online tests was lacking, and the quality of services was variable, with potential short-term and long-term personal, clinical and public health implications.

The researchers said very few online providers met the national STI management standards and that for-profit providers were the least compliant.

This study identified and analysed 31 providers of online tests in the UK, seven of which responded to a survey, and found a lack of health promotion information and triage, use of tests licensed for professional use only marketed for self-testing, inappropriate infections tested for, and incorrect specimen type used.

As a result, it concluded users were at risk of taking unnecessary tests, with poor performance, that could lead to incorrect results, inappropriate management and receiving inadequate clinical information and support.

Additionally, private testing may result in under-reporting to national surveillance systems, posing issues for epidemiological monitoring.

However, the authors said online testing for STIs may help overcome barriers of traditional face-to-face testing, such as stigma and inconvenience.

They also acknowledged limitations, including the low response rate to the questionnaire, the study being unfunded and therefore tests could not be purchased and tested independently, and the sample analysed may not have been fully representative of all providers.

However, the report also referenced studies in other countries that similarly identified suboptimal online testing service provision as a problem across the world and that regulatory change was needed so providers are regularly monitored and can be held to account.

‘Online testing is a welcome addition to STI diagnostics, offering a convenient and flexible option for users. However, the proliferation of providers that do not follow guidelines, in particular for-profit sites, jeopardises these advantages and puts users at risk,’ the editorial said.

‘If current trends continue, online testing usage will increase, resulting in more online providers as demand rises. Regulatory change is required to ensure that the standard of care received online meets national guidelines to protect patients and the wider population from the repercussions of underperforming or inappropriate tests.’

This comes after health officials issued a warning in January on the rise in an ‘extremely antibiotic-resistant’ infection predominantly affecting gay, bisexual and other men who have sex with men.