Table 1

Comparison of current and proposed point-of-care clinical pathways for chlamydia and gonorrhoea testing and treatment

PathwayClinical stepsAs primary pathwayAs additional pathway
Cost per patientTime (min)Cost per patientTime (min)
(A) Testing pathways
Chlamydia and gonorrhoea only
CurrentConsultation→Sample collection*→Health promotion→Off-site sample processing (1–2 weeks)→ Results management→Contact positives£45.3432.8£28.6515.7
POCConsultation→Sample collection*→POCT (90 min)→Results management→Contact positives£38.7621.8£32.5913.4
Sexual health screen for asymptomatic patients
CurrentConsultation→Sample collection*†→Health promotion→Off-site sample processing (1–2 weeks)→ Results management→Contact positives£79.7737.2£54.8612.3
POC1Consultation→Sample collection*†→POCT (90 min)→Results management (POCT)→Off-site sample processing (1–2 weeks)→Results management (HIV, syphilis)→Contact positives£77.4231.2£69.4321.1
POC2Sample collection*‡→POCT (90 min)→Consultation/Results (POCT)→Sample collection†→Off-site sample processing (1–2 weeks)→Results management (HIV, syphilis)→Contact positives£73.5726.2£65.5716.1
Sexual health screen for symptomatic patients
CurrentConsultation→Exam/Sample collection*†→Microscopy→ Health promotion→Off-site sample processing (1–2 weeks)→Results management→Contact positives£99.3847.2£73.8222.3
POC1Consultation→Exam/Sample collection*†→POCT (90 min)→Microscopy→Health promotion→Results management (POCT)→Off-site sample processing (1–2 weeks)→Results management (HIV, syphilis)→Contact positives£100.3952.2£74.9827.3
POC2Sample collection*‡→POCT (90 min)→Consultation/Results (POCT)→Exam/Sample collection†→Microscopy→Off-site sample processing (1–2 weeks)→Results management (HIV, syphilis)→Contact positives£84.4636.2£70.7221.1
(B) Treatment pathways
ChlamydiaResults→Treatment→Partner notification→Supported partner notification£34.8923.5£24.9913.5
Gonorrhoea 1st visitExam/Sample collection* (for NG culture)→Treatment→Health promotion/Partner notification→Off-site sample processing→Supported partner notification£72.0751.0£61.8838.0
Gonorrhoea 2nd visit TOC CurrentSample collection* (for NG culture and NAAT)→Off-site sample processing (1–2 weeks)→Results management£39.9820£32.8910
Gonorrhoea 2nd visit TOC POCSample collection* (for NG culture and POCT)→POCT (90 min)→Off-site sample processing (for NG culture, 2–4 days)→Results management£45.8720£38.7710
  • The clinical pathway steps for chlamydia and gonorrhoea (A) testing and (B) treatment are shown along with cost per patient and minutes of healthcare professionals’ time for each pathway when delivered as either a primary or an additional pathway. The first step, patient registration, is common to all pathways and is not shown. Alternative POC pathways proposed by different clinics are reported as POC1 and POC2. The cost of POC pathways may vary by −£5/+£7 based on volume of tests performed.

  • *Urine/vulvo-vaginal swab collected for chlamydia and gonorrhoea testing.

  • †Blood sample collected for HIV and syphilis testing.

  • ‡Patients would drop off sample and book an appointment later in the day for their consultation and results.

  • NG, Neisseria gonorrhoea; NAAT, nucleic acid amplification test; POC, point-of-care; POCT, point-of-care tests; TOC, test of cure performed four weeks after initial treatment for gonorrhoea.