Discussion
Current Solutions
She explained that STI diagnoses mainly arise in three contexts
- Patients with clinical symptoms
- Patients with a suspected infection
- Cases following sexual assault
The PCR results are typically available within 48 hours, after which patients receive treatment. Some infections (e.g. chlamydia, gonorrhoea) require follow-up testing six weeks later. Certain infections are notifiable and must be reported to the Swiss Federal Office of Public Health (BAG). She emphasized that STI screening currently plays only a minor role, primarily in pregnancy checks or infertility workups.
Barriers to Testing
She highlighted two barriers that prevent people from getting tested: the effort it takes to arrange and undergo testing, and the financial burden, since patients must often cover costs within their deductible under the Swiss system.
Choice of sample
She emphasized that different STIs require different sampling methods. Syphilis testing, for example, always requires a blood sample. For urine-based testing, she explained that the first morning urine is preferred, as it offers the best detection rate. Depending on a person’s sexual practices and possible sites of exposure, additional swabs may be necessary; she underlined the importance of testing at the right place.
However, she mentioned that in men, urethral swabs can be uncomfortable and urine samples often prove to be a viable alternative. For example, Chlamydia and gonorrhea can be detected quite reliably in urine, making this approach practical. Trichomonas, however, is different: while urine testing may work in some cases, it is not sufficiently reliable, especially in women, and therefore requires other methods.
Opinion on Self test
She regarded the concept of an STI self-test as promising, pointing to the success of COVID-19 self-tests and HPV self-sampling programs in other countries. However, she stressed that instructions must be clear about what to do after a positive result, including how urgent (or not) the situation is. At the same time, she warned against the risk of false reassurance if people test too soon after a high-risk encounter.
She noted that it could also be interesting as a point of care device, however, the value of the test would depend heavily on its reliability; if the sensitivity and specificity are comparable to PCR, then receiving results quickly would be highly beneficial.
She also asked about our distribution strategy and highlighted the importance of having an online presence, since many people first turn to Google when they suspect an infection.
Finally, she also emphasized the importance of discussing the project early with SwissMedic, to understand their position on self-tests and clarify what regulatory requirements might apply.
Communicating results
Prof. Dr. med. Betschart emphasized that the way results are communicated is critical, as people react very differently to a positive test. While some remain calm, others experience considerable anxiety or distress. She stressed the importance of ensuring that users immediately know where to turn for help. To address this, she recommended providing direct access to support, by providing clear guidance, ideally through a 24/7 hotline, so that no one is left alone with potentially overwhelming news. The emotional impact also depends on the infection: HIV has long carried a lot of weight, whereas chlamydia is often asymptomatic and generally perceived as less alarming. Professional follow-up is therefore indispensable—not only to confirm the result, but also to reassure patients and guide them through the appropriate next steps.
Clinical validation and regulation
She explained that once a prototype is ready, the first step would be to decide in which canton the study should take place, since regulations vary regionally. The project would then have to be submitted to an ethics committee (KEK), complete with formal procedures such as informed consent. She stressed that such a study would not only fulfill regulatory requirements but also provide valuable insights into how patients use the test, how it is accepted, and what behaviors it might influence.
