Sexually transmitted infections (STIs)
Home HIV Testing (self-testing And Self-sampling)
Key pointsHIV testing is usually provided by medical professionals in hospital clinics, GP surgeries and other settings. It may also be provided by trained staff from HIV and community health organisations. In addition, there are two different ways you can get tested for HIV at home:
You don't need to see a doctor or nurse, and you can use these kits wherever you want, including at home. For that reason, both approaches are often referred to as 'home testing'. For clarity, this factsheet uses the terms 'self-sampling' and 'self-testing'.
Self-samplingIn the UK, many sexual health clinics offer free self-sampling services, and they may also be available online through websites like freetesting.Hiv. Commercial companies including Lloyds Pharmacy and Superdrug also offer self-sampling kits. Self-sampling has always been legal in the United Kingdom.
There are some differences but generally the services work as follows:
You might be able to send samples to test for sexually transmitted infections like chlamydia and gonorrhoea at the same time. For example, you'd need to take a swab from the urethra, vagina, cervix, throat and/or rectum. A blood sample can also be tested for syphilis. One advantage of self-sampling over self-testing is that you can be tested for more infections at the same time. There aren't any self-tests for chlamydia or gonorrhoea.
Self-testingSelf-testing is different from self-sampling in that you perform the whole test yourself and you get the result immediately.
Rev. Jide Macaulay talks about how easy it is to get tested for HIV and why testing is so important.
It used to be illegal to sell or advertise HIV self-testing kits in the UK – HIV testing equipment could only be sold to medical professionals. These restrictions were lifted in April 2014. Testing kits designed to be used by members of the public can be sold as long as the kit carries a CE mark to show it meets European performance and safety requirements.
At present, three CE marked tests are available. The first two involves using a safety lancet to produce a drop of blood from a finger and applying the blood to the test device. The tests' names are the INSTI HIV Self Test and the Newfoundland HIV Test. The result can be read instantly (INSTI) or after 15 minutes (Newfoundland). Studies suggest that the tests are very accurate, except for cases of recent infection.
The third test is the OraQuick In-Home HIV Test. This needs a sample of moisture from the mouth and gives results in 20 minutes. It isn't quite as reliable as the tests used by medical professionals – in a study it gave an accurate result to 93% of people who had HIV and 99.9% of people who did not have HIV.
The tests are sold for between £15 and £30 through the manufacturers' websites: INSTI, Newfoundland and OraQuick, as well as from online pharmacies.
In addition, unregulated self-testing kits continue to be available from internet retailers. These kits may not meet European standards and may give inaccurate results. They may have been designed for use by medical professionals and be difficult for others to use correctly.
How reliable are these tests?The HIV tests licensed for use in the UK are extremely accurate. Nonetheless, no medical test is perfect. For this reason, medical professionals never tell someone they have HIV on the basis of one test result – if the result suggests infection with HIV, it must be confirmed with two more tests, using a different type of test kit each time.
The same rules apply with self-sampling and self-testing.
If a test shows you might have HIV then you'll need to take more tests to confirm the result. These extra tests are best done at a sexual health clinic, where they have access to the most accurate HIV testing technologies.
Clinic staff can also give you support and medical care.
If there are no signs of HIV ('HIV negative'), you need to take into account the test's 'window period'. In general, tests are not able to detect HIV until a few weeks after it was caught. The window period varies; some of the difference depends on the type of sample.
Some self-sampling services ask you to collect a tiny tube of blood, which you send off to a laboratory. In this case, the window period is the same as for many HIV tests used by health professionals. The test is usually able to detect HIV that was caught four weeks (one month) ago. But occasionally it can take up to 12 weeks (three months).
The INSTI HIV Self Test has a similar window period. It will usually be able to detect HIV that was caught four weeks (one month) ago. But occasionally it can take up to 12 weeks (three months). The manufacturer of the Newfoundland HIV Test say that their window period is 12 weeks (three months).
If the sample is moisture from your mouth, the window period may be longer. It may also be a little longer if the sample is a drop of blood squeezed onto a piece of paper. In these cases, tests are frequently able to detect HIV that was caught between four and eight weeks ago. But it may take up to 12 weeks for infections to be detected. This applies both to self-sampling using these kinds of samples and the OraQuick self-test.
Glossary self-testingIn HIV testing, when the person testing collects their own sample and performs the whole test themselves, including reading and interpreting the result.
self-samplingIn HIV testing, when the person testing collects their own sample and sends this to a laboratory for analysis. The lab makes the results available by phone or text message a few days later.
sampleStudies aim to give information that will be applicable to a large group of people (e.G. Adults with diagnosed HIV in the UK). Because it is impractical to conduct a study with such a large group, only a sub-group (a sample) takes part in a study. This isn't a problem as long as the characteristics of the sample are similar to those of the wider group (e.G. In terms of age, gender, CD4 count and years since diagnosis).
window periodIn HIV testing, the period of time after infection and before seroconversion during which markers of infection are still absent or too scarce to be detectable. All tests have a window period, the length of which depends on the marker of infection (HIV RNA, p24 antigen or HIV antibodies) and the specific test used. During the window period, a person can have a negative result on an HIV test despite having HIV.
home testingThe term may be used to describe either self-testing or self-sampling.
The information on window periods means that if you test less than 12 weeks after an activity which could have exposed you to HIV (like sex without a condom), then an HIV-negative result is not definitive. You can only be sure by testing 12 weeks after the last risky activity.
One specific situation in which self-tests are not reliable is when you are taking antiretroviral medications, either as HIV treatment, pre-exposure prophylaxis (PrEP) or post-exposure prophylaxis (PEP). For example, sometimes people have a doubt about their HIV diagnosis and use a self-test to check or reconfirm their HIV status. The results are sometimes inaccurate in these situations.
The vast majority of people are likely to receive accurate results when using self-sampling and self-testing. They are also convenient ways to test. However, if you have any concerns, you may prefer to test at a clinic, where they use the most advanced HIV testing technologies.
Choosing the right test for youMany people prefer home testing because it's quick, doesn't require a trip to a clinic and may feel more private. The convenience of these services could help you to test regularly. Home-testing kits have been designed to be easy to use. Nonetheless, you need to follow the instructions carefully to get an accurate result.
Some people prefer to go to a clinic where they are tested by a medical professional and can also be tested for other sexually transmitted infections. Also, if the test result is unclear or might be positive, staff can give you advice and check the result with additional tests straightaway.
Before testing by yourself, it's worth thinking about how you would cope if the test showed you might have HIV. It may be up to you to seek advice and support. This will be available from the service providing the test, local HIV organisations, sexual health clinics and HIV clinics. It would be very important to go to a clinic to have the test result checked.
HIV testing offered by NHS clinics and charities is free of charge. However, a service offered by a private company may cost around £40.
Chlamydia Sex Infection Vaccine Passes Safety Test
A vaccine to protect people against the common sexually transmitted infection chlamydia has passed initial safety tests.
It is the first of its kind to enter human trials.
Experts say immunisation may be the best way to tackle the disease that accounts for nearly half of all sex infections diagnosed in the UK.
Those tests will take years and in the meantime the best way to avoid getting chlamydia during sex is by using a condom.
What is chlamydia?
It is a bacterial infection that is passed on through unprotected sex (even if there is no penetration).
Chlamydia bacteria reside in semen and vaginal fluid. Often, the infected person will have no symptoms, which is why people sometimes refer to it as a "silent" disease.
If it is not treated with antibiotics, it can cause serious complications and affect fertility.
People under 25 who are sexually active are advised to get tested for chlamydia every year. The NHS offers a free screening service. People can also buy self-testing kits from pharmacies to do at home with a swab or urine sample.
Why do we need a vaccine?
Although antibiotics can treat chlamydia, people can catch the infection again if they come into contact with it.
Chlamydia remains the most common STI despite screening and effective treatment being available.
Vaccination could offer long-lasting protection, experts hope.
In the trial, researchers from Imperial College London compared two different formulations of the vaccine alongside a dummy or placebo jab in 35 women.
Both formulations appeared to be safe, but one stood out as a front runner. The researchers now want to move this vaccine into the next phase of testing.
Investigator Prof Robin Shattock said: "The findings are encouraging as they show the vaccine is safe and produces the type of immune response that could potentially protect against chlamydia.
"The next step is to take the vaccine forward to further trials, but until that's done, we won't know whether it is truly protective or not.
"We hope to start the next phase of testing in the next year to two. If those trials go well we might have a vaccine that can be rolled out in around five years."
He suggested it could potentially be offered alongside the HPV jab that is currently used to protect against cervical cancer.
A spokeswoman from the young people's sexual health and wellbeing charity Brook, said: "Whilst these initial results are promising, it's still very early days and a widely available vaccine could be years in development.
"We would be thrilled to see a vaccine for chlamydia in the future and we are hopeful that this will become a reality.
"As diagnoses of STIs continue to increase national and globally, including antibiotic-resistant gonorrhoea, it remains essential that people use condoms to protect themselves."
Sex diseases on the rise in England
Can HPV Self-Tests Truly Replace Pap Smears?
Back in May of this year, the FDA approved a new method of human papillomavirus (HPV) testing in a healthcare setting. Rather than a standard Pap smear performed with a speculum -- a test dreaded by many patients -- the new test allows for patients to swab their own vagina using a long cotton swab.
The Roche Cobas HPV assay and the Becton Dickinson Onclarity HPV assay are set to launch this fall with expanded indications for use that "allow for the patient to self-collect a vaginal swab in a healthcare setting when the patient and the healthcare provider determine that it is not possible for the clinician to collect a cervical specimen," according to an FDA announcement.
While these HPV self-collection tests have several upsides, ob/gyns told MedPage Today that they don't completely replace the utility of the Pap test -- and the U.S. Is still behind other countries when it comes to self-collection tests.
Pamela Berens, MD, an ob/gyn at the McGovern Medical School at UTHealth Houston, told MedPage Today that providers gather more information than just the Pap smear when performing the test. They're conducting a pelvic exam, looking at the cervix for irregularities like polyps, and observing any unusual discharge that could indicate a yeast infection or bacterial vaginosis.
Plus, they're actually conducting dual testing: the Pap itself and HPV testing, which have two separate results. At the same time, the ob/gyn might add on testing for sexually transmitted infections (STIs) like gonorrhea or chlamydia, though Berens said that many STIs could instead be detected via urine testing.
Berens noted that while some aspects of Pap and HPV testing have remained the same -- using a speculum to access the cervix, taking a sample of cells, and having it tested in a lab to look for precancerous cells -- the Pap test itself has already evolved over the years.
"Over time, we switched from using a flat slide -- where you'd actually put the cells from the cervix on the slide -- to doing it in a solution ... And the solution made Pap smears much better," Berens said. Then in the 90s, HPV testing became routine and the samples were analyzed for HPV type 16, 18, and 45, which are most associated with cervical cancer.
Shae Connor, MD, a gynecologic oncologist at UT Erlanger Women's Oncology in Chattanooga, Tennessee, told MedPage Today that as a whole, standalone HPV testing is equivalent to cytology plus HPV testing.
"That's hard for many physicians to swallow because we got so reliant on the Pap smear," she said. "The Pap smear is actually a really bad test."
Connor explained that with cytology alone, the test's "sensitivity is terrible and the specificity is even worse ... So when you look at HPV standalone testing, it's actually just as good as Pap plus HPV." Indeed, research from earlier this year found that HPV testing outperformed Pap smear in detecting cervical cancer precursor lesions.
Berens and Connor both noted that the HPV self-collected swab test would be more influential if it was also approved for at-home use.
"In Canada and Europe, at-home, self-collection tests have been used for years with really excellent results," Connor said. "There's plenty of data in those countries that wide implementation of self-collection kits at home increases screening rates, which overall decreases rates of cervical cancer." Last year, a U.S.-based trial found that mailing patients HPV self-sampling kits boosted cervical cancer screening.
Connor said she suspects that part of why the U.S. Has been so slow to adopt the HPV self-test is mistrust in the patient's ability to self-collect, though she also noted that data indicate that self-collection is equally efficacious. The swab only needs to reach the vaginal wall -- which is easier to reach than the cervix -- in order to pick up the HPV virus.
"The whole approving it for in-office use is a little bit counterproductive, because we're not going to reach more people if they already have to come into the office to do the initial test -- we're not going to reach any more people than the folks who are going to come in for a Pap smear," Connor noted.
Berens also pointed out that most other countries where the test is used have a universal healthcare system. In that context, if there's a positive result, a patient can simply go see a doctor without worrying about cost or access. But in the U.S., patients may be left unable to seek care if they get a positive or inconclusive result. Still, Berens said this new in-office option will be good for patients with phobias of pelvic exams, adding that's where there will immediately be uptake.
Connor added that feeling emotionally, physically, or psychologically uncomfortable with a test is "the primary reason that women avoid the gynecologist -- other than lack of health insurance or financial reasons -- because it can be a traumatizing experience, especially for anyone who has a history of sexual trauma or abuse."
Even within this group, if the HPV test comes back positive, Berens said patients may still end up needing a physical pelvic exam.
"It kind of got you out of the first exam, but now I'm going to need to do the exam," she said, noting that a colposcopy would likely be the next step.
Rachael Robertson is a writer on the MedPage Today enterprise and investigative team, also covering OB/GYN news. Her print, data, and audio stories have appeared in Everyday Health, Gizmodo, the Bronx Times, and multiple podcasts. Follow
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