STD Testing Practices in United States Public Health Laboratories

Background: Public health laboratories (PHLs) play a unique role in STD control and prevention.  They serve as diagnostic labs, as reference labs, as subject matter experts and as applied research centers. In 2011, Association of Public Health Laboratories (APHL) and CDC fielded a survey to characterize the role of PHLs in STD prevention.

Objectives: To determine the current STD testing capabilities and capacities of United States (US) state and local PHLs.

Methods: In March 2011, APHL launched a survey to determine the status of STD testing activities from January 1 to December 31, 2010. The survey consisted of 56 questions and was distributed electronically to 95 US state and local PHLs.

Results: The overall response rate was 68%. Of 76 laboratories, 78.9% perform Chlamydia testing.  Fifty-eight percent of 62 laboratories accept vaginal swabs for Chlamydia testing and 42% and 35.5% accept anorectal and oropharyngeal swabs, respectively. Of 67 laboratories, 89.6% perform gonorrhea testing. Gen-Probe Aptima Combo 2 is the primary method used to identify Chlamydia trachomatis and Neisseria gonorrhoeae. About 24% percent of 65 laboratories performed gonorrhea susceptibility testing, of which the primary method used is disk diffusion (47%). Fifty-five out of 65 laboratories (84.6%) conducted Chlamydia/gonorrhea combo NAAT testing, of which 16% pooled specimens. Fifty out of 67 (74.6%) laboratories perform syphilis testing, of which 54/61 (88.5%) do initial screen using a non-treponemal assay.

Conclusions: PHLs remain an important partner in the public health system’s response to STD prevention.  However, eroding budgets, a significant workforce shortage, and the increased presence of the private sector in STD testing endanger the unique services that PHLs offer.

Implications for Programs, Policy, and Research: PHLs continue to play an important role in STD testing as well as provide support for public health providers, health departments, and community health centers and clinics.