Sexually transmitted infections (STIs) are a significant and growing public health challenge worldwide. Despite continued efforts to raise awareness and improve prevention, STI rates are on the rise, with young adults, adolescents, and underserved communities being disproportionately affected.1 Traditional diagnostic methods, which rely on centralized laboratory testing, are often slow, costly, and inaccessible, contributing to delayed treatment, rising healthcare costs, and missed opportunities for early intervention. Antimicrobial resistance (AMR) in STIs, particularly in Neisseria gonorrhoeae (NG), is compounding this challenge. NG is increasingly resistant to first-line antibiotics, making timely and precise diagnosis more crucial than ever.2 In this article, we explore how molecular point-of-care (mPOC) testing can increase accessibility and improve treatment outcomes by offering a faster and more affordable approach to STI care. Insights from Dr. Shah and Dr. Culbreath, both leading experts in infectious disease management, underscore the potential of mPOC to transform STI care.
The current state of STI testing: A time-consuming process
Conventional STI testing often involves sending patient samples to centralized laboratories, which can be located far from the care setting. This process typically results in a waiting period of up to four days. Such delays can be problematic in terms of both diagnosis and treatment. Dr. Shah explained, “The current system of sending samples off to a lab creates significant challenges for clinicians. The waiting period not only makes follow-up difficult but also increases the chances of patients being lost to follow-up. Additionally, patients may be started on broad-spectrum antibiotics before receiving definitive results, which can contribute to over-treatment.”
Over-treatment is a significant concern in STI management.3 This occurs when antibiotics are prescribed before a confirmed diagnosis, leading to the risk of unnecessary prescriptions. Overuse of antibiotics contributes to antibiotic resistance, a growing global health threat. NG, in particular, has exhibited increasing resistance to multiple classes of antibiotics, including cephalosporins, macrolides, and fluoroquinolones, making treatment more difficult and reinforcing the need for accurate, timely diagnostics. However, if providers don’t treat while the patient is in the office, there is a risk of untreated STIs, which can have serious health consequences, including infertility, chronic pain, and increased risk of HIV transmission.4 These risks and complications could be mitigated with faster, more accurate diagnostic methods.
A faster, smarter approach: The benefits of molecular point-of-care testing
mPOC testing provides a much-needed solution for certain populations who require immediate results instead of the delayed outcomes associated with traditional lab-based diagnostics. Unlike conventional tests that require samples to be sent off for analysis, mPOC technology allows clinicians to perform tests directly in the clinic, delivering real-time results within a single healthcare visit. This approach significantly reduces the waiting period and enables immediate action.5 Dr. Culbreath pointed out, “The primary advantage of mPOC testing is speed. With these tests, clinicians get immediate feedback, allowing them to begin treatment right away. This reduces the chance of a patient being lost to follow-up and prevents further transmission of infections.”
For healthcare providers, the speed of mPOC testing also contributes to more precise treatment decisions. By eliminating the uncertainty and wait time of lab-based diagnostics, clinicians can more confidently prescribe the appropriate treatments, reducing the likelihood of over-prescribing antibiotics. Moreover, mPOC testing aids in antibiotic stewardship by potentially reducing antibiotic overuse for the treatment of STIs. By offering real-time diagnostic results, mPOC testing ensures that antibiotics are only prescribed when truly necessary, thereby contributing to better stewardship of these critical resources.
Expanding access: Bringing testing to communities
One of the key advantages of mPOC testing is its ability to bring diagnostics directly to communities with limited healthcare access, especially in rural or underserved urban areas. mPOC can be deployed in places like schools, mobile health units, and pop-up clinics, making testing accessible to populations that might otherwise face delays. Dr. Shah explains, “Instead of patients having to travel to a lab, mPOC allows healthcare providers to bring the diagnostic process to them, which is especially valuable for remote communities or those facing barriers to regular healthcare.”
Dr. Culbreath adds, "We’re creating new access points because current ones are stretched beyond capacity. Placing tests in existing health systems, like at PCPs and mobile clinics, will relieve stress on resources and meet community needs." Community-based testing, successful in areas like respiratory virus testing, could be adapted for STIs, improving access to diagnoses, treatment, and reducing stigma.
Operational efficiencies and cost savings through decentralized STI testing
In addition to a high burden of STIs for individuals with limited access to regular healthcare services, the cost of accessing care is an additional barrier for broadening STI diagnosis and treatment. Dr. Shah noted that “Cost is probably the biggest barrier for a lot of individuals in coming back to an urgent care setting or hospital-based setting for re-testing.” He goes on to explain that sending samples from an urgent care clinic to a hospital or reference lab for centralized molecular testing can result in very expensive patient bills, especially for individuals with increasingly common high-deductible health insurance plans or those who are uninsured. He continues that these costs for the individual “might disincentivize patients to even seek further care.”
Alternatively, if mPOC solutions were available in these decentralized settings, such as local clinics, urgent care centers, or mobile units, there may be an opportunity to reduce the potential downstream costs to the patients, provide immediate care, and reduce loss to follow-up.
While mPOC testing is cost-effective in many settings, it may not always be the most appropriate choice for every situation. In some cases, traditional lab tests may still be necessary for their accuracy or comprehensive panels. Nonetheless, for many patients, mPOC testing represents an affordable, efficient solution.
Overcoming the implementation challenges
While mPOC testing holds great potential, several barriers exist to its widespread adoption, particularly the need for proper training. Healthcare workers must be skilled in specimen collection, handling, and test interpretation. Dr. Shah stresses, “Training is essential. Healthcare workers must be familiar with the proper use of mPOC tests, the importance of maintaining a clean testing environment, and accurate interpretation of results. This ensures the tests deliver reliable outcomes and that patients receive the best possible care.”
Additionally, clear clinical guidelines must be established to ensure consistency in the use of mPOC testing across various healthcare settings.4,6 As mPOC tests become more widespread, it is important to standardize protocols to ensure their correct application.
Extragenital testing for sources, including the throat or rectum, is another critical issue. Dr. Culbreath notes, “Without extragenital testing, we risk missing a significant portion of infections, especially in high-risk populations. Ensuring these tests are available is vital to capturing the full scope of STI transmission.” She adds, “Extragenital sampling is crucial, as up to 50% of infections can be found in these areas.”
The physician’s role in adopting new testing methods
The process of adopting new technologies can be complex for hospital administrators. While the clinical value of these tests is clear, the evaluation and consideration of new technologies often involve a careful balance between clinical benefits and financial implications. Dr. Shah shares, “There are times when physicians advocate for specific tests, but administrators may be slow to adopt them due to financial constraints. However, as we move forward, mPOC testing is proving to be a cost-effective investment.”
The rising demand for easier-to-use, rapid turn-around time testing means that healthcare systems are increasingly interested in adopting mPOC tests. This is particularly true in urgent care centers, where clinicians need rapid, accurate results for a wide range of conditions.
The future of molecular point-of-care testing in STI management
Looking to the future, mPOC testing is set to become a cornerstone of STI management. As technology improves, the cost of these tests will continue to decrease, making them even more accessible. This will expand opportunities for early detection and intervention, helping to reduce the incidence of STIs and associated complications. Dr. Culbreath concludes, “The future of STI care will be shaped by rapid, point-of-care diagnostics. With the continued development of mPOC technology, we can look forward to a world where testing and treatment are faster, more efficient, and more widely accessible, leading to better public health outcomes.”
Conclusion: A new era in STI testing
mPOC testing is transforming the landscape of STI diagnosis and treatment. By providing fast, accurate results at the point of care, mPOC tests can improve patient outcomes, enhance access to care, and reduce the overall burden on the healthcare system. As we move forward, the integration of mPOC testing into routine STI care holds the promise of a more effective, equitable approach to tackling the silent epidemic of STIs.
With proper training, guidelines, and implementation strategies, mPOC testing can become a powerful tool in the fight against STIs, ultimately leading to healthier communities and better healthcare outcomes for all.
REFERENCES
1. National Academies of Sciences, Engineering, and Medicine;Health and Medicine Division;Board on Population Health and Public Health Practice;Committee on Prevention and Control of Sexually Transmitted Infections, Crowley JS, Geller AB, Vermund SH. Addressing STI Epidemics: Integrating Sexual Health, Intersectionality, and Social Determinants. National Academies Press; 2021.
2. CDC. Pilot to test for drug-resistant gonorrhea in emergency departments. Antimicrobial Resistance. February 4, 2025. Accessed March 26, 2025. https://www.cdc.gov/antimicrobial-resistance/stories/gonorrhea-testing.html.
3. CDC. 2019 antibiotic resistance Threats Report. Antimicrobial Resistance. February 5, 2025. Accessed March 26, 2025. https://www.cdc.gov/antimicrobial-resistance/data-research/threats/index.html.
4. CDC. STI treatment guidelines. Centers for Disease Control and Prevention. Accessed March 26, 2025. https://www.cdc.gov/std/treatment-guidelines/default.htm.
5. 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.
6. Chlamydia and gonorrhea: Screening. Uspreventiveservicestaskforce.org. September 14, 2021. Accessed March 26, 2025. https://www.uspreventiveservicestaskforce.org/uspstf/recommendation/chlamydia-and-gonorrhea-screening.
