On the spot: How point-of-care testing is tackling rising STI rates

We’re talking about point-of-care testing. And today, to explore this innovation and to glimpse into the future of point-of-care testing for STIs, I’m delighted to be joined by Dr. Libby Van Gerwen.

Libby is currently an Assistant Professor in the UAB Division of Infectious Diseases in her beautiful hometown of Birmingham, Alabama.

Welcome to our podcast, Libby. It’s a real honour to have you with us today.

[Libby Van Gerwen]: Thanks. I’m excited to talk about this really interesting and important topic with you all.

[Gina Furnival]: I know we’ve had the pleasure of working together recently quite a bit on our new website, touchINFECTIOUS DISEASES, and also on our journal. But one question we’ve probably never asked you is what actually drove you to pursue a career in infectious diseases, and in particular STIs?

[Libby Van Gerwen]: That’s a question I get asked a lot, as you would imagine. I ended up going into medicine because I was very interested in public health. I grew up in the Deep South. Here in the US, in the Deep South, we have a lot of health disparities. We have a lot of issues with poor health outcomes, especially in the realm of infectious diseases. Like, HIV is very prevalent here, and we have a lot of struggles with that. I went into medicine with that passion in my heart. During my residency training for internal medicine in New Orleans, Louisiana, I saw heartbreaking but also medically fascinating cases of HIV and complications related to it. This heightened my interest from a medical and personal perspective.

Coming back to Birmingham for my fellowship, I became interested in not only HIV but also other sexual health issues people face, such as bacterial STIs, parasitic STIs, and the challenges that queer and other LGBTQ individuals encounter.

[Gina Furnival]: People have heard the term STI before, but could you tell us what the primary infections are that come under that term?

[Libby Van Gerwen]: Sexually transmitted infections encompass a wide range of infections that fall into viral, bacterial, and parasitic categories. The bacterial ones we commonly think of include syphilis, gonorrhoea, and chlamydia—three of the most widespread infections worldwide. The viral group is more diverse, with systemic impacts. These include HIV, Hepatitis C, and herpes simplex.

One of my favourites is the parasitic STI, trichomonas. It’s very common, yet underappreciated, with significant effects like adverse birth outcomes for women and vaginitis symptoms. It can also impact men symptomatically.

[Gina Furnival]: In terms of complications, you’ve touched on pregnancy outcomes. Are there other long-term impacts to look out for?

[Libby Van Gerwen]: Yes, and the impacts vary depending on the infection. For instance, untreated HIV can lead to severe immune system compromise and involve multiple organ systems. However, for non-HIV STIs, bacterial infections like chlamydia and gonorrhoea can cause fertility issues and chronic pelvic pain, especially for those assigned female at birth. Pelvic inflammatory disease, caused by these infections, can lead to scarring in the reproductive tract, which may result in infertility.

Syphilis also presents serious congenital issues. In the US, we’re facing a severe congenital syphilis problem, where untreated syphilis in mothers can be passed to the fetus, leading to stillbirth or serious birth defects, such as neurological problems or seizures.

[Gina Furnival]: A lot of this seems focused on women and reproductive health. Are there other communities or populations that are more affected by STIs than others?

[Libby Van Gerwen]: Absolutely. I have a bit of a bias since I do a lot of work with the LGBTQ population. Many in this community experience higher burdens of STIs compared to others. Men who have sex with men, transgender people, and sex workers are some of the groups most affected. These populations face systemic pressures that lead to risky sexual behaviors, but they are also underserved by the healthcare system, often due to stigma surrounding both their identity and the risk of STIs.

[Gina Furnival]: You’ve mentioned regional differences in the US. What about globally? Are there regions more affected than others?

[Libby Van Gerwen]: Yes, this is a global issue. In the US, the Deep South is a hotbed for STIs, but globally, resource-limited countries, especially in Africa, experience high burdens of HIV and other STIs. Stigma related to sexual health and limited resources for testing and treatment play a huge role. Urban centers and rural areas in other parts of the world face similar issues.

[Gina Furnival]: The World Health Organization figures from 2020 show 374 million new cases a year of the four main STIs. Correct me if I’m wrong, but there are now many effective treatments available. Why are cases still rising?

[Libby Van Gerwen]: It’s complicated. Stigma plays a big role—people may not think they’re at risk or may not want to talk about sexual health, so they don’t get tested. In many communities, discussing these issues can be dangerous, especially in places like Africa where women might not feel safe talking to their partners about sex. In the US, suboptimal sexual health education is another issue, with a focus on abstinence-only rather than prevention.

[Gina Furnival]: Moving to testing, has the lack of testing impacted the figures we see? Are people going for tests and getting their results?

[Libby Van Gerwen]: Definitely. People often don’t realize they’re at risk, or they don’t want to go to the doctor for sexual health concerns. Many are asymptomatic, so they don’t get tested unless it’s part of a regular screening. The CDC and WHO recommend asymptomatic screening for certain populations, but many people don’t follow this guidance.

[Gina Furnival]: And for those who do get screened and diagnosed, does treatment adherence impact the numbers?

[Libby Van Gerwen]: Yes. Some infections, like gonorrhoea, can be treated with a single shot, but others, like complicated syphilis or herpes, require longer treatment courses. People may not pick up their medication, may not finish it, or may not get their test results in time. Public health infrastructure tries to prevent this, but gaps remain.

[Gina Furnival]: Point-of-care testing was designed to address some of these challenges. How has it transformed the diagnosis and management of STIs?

[Libby Van Gerwen]: Point-of-care testing is a game changer. In the US and other major countries, there are point-of-care tests for most STIs. These tests provide results in under 60 minutes, allowing treatment to begin before the patient leaves. This is especially important in resource-limited settings and emergency departments where follow-up is difficult.

[Gina Furnival]: You mentioned antimicrobial stewardship earlier. How does point-of-care testing help prevent antimicrobial resistance?

[Libby Van Gerwen]: Point-of-care tests help avoid unnecessary antibiotic use by providing accurate diagnoses in real-time. This reduces the risk of side effects from unnecessary treatments and helps prevent the overuse of antibiotics, which contributes to resistance.

[Gina Furnival]: Are these tests cost-effective, and how do they impact healthcare settings?

[Libby Van Gerwen]: It depends on the test and the setting. In places like resource-limited countries or emergency departments, they can be very cost-effective. Some tests require expensive equipment, but over time, they become more economical if they fit the clinical setting.

[Gina Furnival]: Where has point-of-care testing had the biggest impact so far?

[Libby Van Gerwen]: Resource-limited settings, particularly in Africa, have benefited greatly from point-of-care testing. It’s reduced STI rates in some regions and made testing more acceptable for patients.

[Gina Furnival]: What do you think makes an ideal point-of-care test?

[Libby Van Gerwen]: An ideal test needs to be sensitive, specific, accessible, and cost-effective. It must provide accurate results, reach populations with limited access to healthcare, and be affordable for both the healthcare system and the patients.

[Gina Furnival]: What next-generation point-of-care tests are being developed, and how might they impact diagnosis and treatment?

[Libby Van Gerwen]: The future is heading towards tests that can be used by patients at home. This would allow them to test themselves and get results without needing to visit a clinic. We’re not quite there yet, but that’s the next frontier for point-of-care testing.

[Gina Furnival]: Dual tests and comprehensive panels that detect multiple infections simultaneously—what is the future of those?

[Libby Van Gerwen]: These tests are evolving rapidly. We started with two-infection panels like gonorrhoea and chlamydia, and now we’re seeing panels that can detect up to ten organisms. However, interpretation becomes a challenge, especially when tests detect organisms that aren’t causing disease.

[Gina Furnival]: We recently received a paper on drug-resistant strains of infections. Are point-of-care tests available for these?

[Libby Van Gerwen]: Yes, there are point-of-care assays for drug-resistant strains, such as Mycoplasma genitalium and even gonorrhoea. These technologies are in use and may be more widely available soon.

[Gina Furnival]: Is point-of-care testing impacting vaginitis, even though it’s not typically thought of as an STI?

[Libby Van Gerwen]: Bacterial vaginosis (BV) is a complex condition that’s sexually associated, but not strictly transmitted. There are molecular tests available to detect the bacteria involved in BV, but these aren’t point-of-care yet. At the moment, we rely on wet mount microscopy to diagnose BV in real-time.

[Gina Furnival]: The future of point-of-care testing seems busy and exciting! Thank you for joining us today, Dr Libby Van Gerwen, and for highlighting the importance of diagnostics.

[Libby Van Gerwen]: Absolutely. We often take diagnostics for granted, but they play a crucial role in understanding and managing infections. I’m glad we could dive into this important topic.

[Gina Furnival]: And for those listening today, before you go, please don’t forget to subscribe to our series by going to Podbean and searching Visionary Voices, Insights from Healthcare Professionals. You can also find us on LinkedIn by searching Touch Medical Media. Until next time, take care. It’s goodbye from me.