Background:
In 2003 Internet Sexuality Information Services (ISIS) partnered with San Francisco Department of Public Health (SFDPH) to provide a simple and free way for San Francisco residents to request a syphilis test slip online and receive secure results electronically. Of all STDtest.org testers, 51/801 (2.3%) were positive. Now, ISIS and SFDPH are expanding STDtest.org to include testing for gonorrhea, Chlamydia, herpes and HIV, with HIV results coordinated through clinical services at the San Francisco's municipal STD clinic.

Objective:
The goals of STDtest.org expansion include: 1. Re-design STDtest.org to provide online testing recommendations based on local epidemiology, 2. Provide free testing services for multiple STDs with results securely available online.

Method:
Community advisory board met twice to envision a more comprehensive online testing service. SFDPH staff worked with Labcorp to negotiate test prices, and engineers built an improved site, adding a testing recommendation tool and comprehensive STD/HIV information.

Result:
Community advisory board advised keeping the service free. They wanted website images to reflect a wide audience regardless of high-risk groups. They wanted to expand the capability of Labcorp to be able to provide testing for anal and oral gonorrhea and chlamydia in the future. The enhanced STDtest.org site will launch in January '08 and will rely on donations to maintain the service and cover testing costs.

Conclusion:
Expansion of STDtest.org is a logical way to reach a variety of people who might be apprehensive about getting a doctor ordered test face-to-face or who may not have the time or money to visit a clinic. With additional funding in the future, we hope to expand STDtest.org to a national public health online testing service.

Implications:
Online testing may be a cost effective way to test a large number of people. Widespread use of STDtest.org may show that online test result dissemination is a trusted system.