Many infection cases go unnoticed by the healthcare service

The healthcare service is falling behind when it comes to testing for sexually transmitted diseases (STDs). That’s become evident from a pilot project conducted with particular at-risk groups at RFSL’s Counselling Service in Skåne (RFSL is the Swedish Federation for the Rights of LGBTQI People). We believe the healthcare service needs more knowledge within this area, as well as access to better tools to improve quality and equality.

Today, tests are carried out at healthcare centres, gynaecological clinics, youth clinics, and skin and genital clinics. STDs are generally only tested genitally. However, it is becoming more common to be infected orally and anally, meaning it is not sufficient to only test genitally (vaginal or urine tests), particularly for at-risk individuals such as men who have sex with other men (MSM) and trans people. In addition, many infections go unnoticed by the healthcare service, which may be a reason why we are seeing a marked increase in the occurrence of STDs in Sweden today.

We often meet the at-risk groups, MSM and trans people, at RFSL Counselling in Skåne. We see how inadequate testing within the healthcare system contributes to the spreading of more infections and how people are being discriminated against. Many people explain how they only are offered genital testing at the traditional healthcare service. People describe how they are asked inappropriate questions and that they are concerned about how the information will be used if they request to be tested at several clinics.

To address these shortcomings and increase the testing frequency of MSM and transgender people, RFSL Counselling Skåne and HealthTech company Dynamic Code have jointly carried out a pilot project for the past couple of years at RFSL’s office. 100 self-test packages with triple sampling were handed out to the at-risk groups. The test is done orally, anally and genitally and shows if the person has chlamydia, gonorrhoea, mycoplasma and/or trichomonas.

After having had time to follow up on the project, we find the results remarkable. Several people say they are very pleased to be able to perform the test themselves and avoid being exposed to uncomfortable questions at healthcare centres and other clinics. Further, we discovered the significant issues that arise when sampling is only performed genitally: of the 14 positive test results in our project, 12 of these infections were found through other sampling than genital sampling. STDs such as gonorrhoea and chlamydia can be found in several different places and it is a fundamental right to be tested based on one’s own personal sexual practices. The healthcare service generally advocates testing when there are symptoms, and as sexually transmitted infections can also be symptom-free, many do not do any testing at all.

We want to offer this test in the future as well and we want adequate tests to be accessible at all healthcare centres in Skåne. It should be a basic service that at-risk individuals across the country have the opportunity to do both genital, oral and anal STD self-tests. In our opinion, the availability of symptom-free STD testing must improve, particularly for at-risk groups such as men who have sex with men (MSM) and transgender people.

The healthcare service must provide a sufficiently high service quality, regardless of which clinic the individual consults – and independent of the individual’s sexual practices.

Anne Kihlgren,
founder CEO Dynamic Code

Niklas Eriksson,
project developer RFSL Counselling Service in Skåne (RFSL Rådgivningen Skåne)