Digital technology and self-care in sexual health

In recent years, digital advances have revolutionised the field of sexual health, bringing about significant improvements in both prevention and care. From the development of highly effective diagnostic tools, such as rapid testing for HIV and sexually transmitted infections (STIs), to the rise of mobile health (mHealth) and telemedicine, digital technology may empower individuals and provide unique opportunities for better service provision. These innovations not only enhance accessibility and convenience but also reduce stigma, offering a more inclusive approach to sexual health care that reaches diverse populations across the globe. However, these same technologies may expand inequalities, entrench power imbalances, and contribute to stigma. This underscores the need for high-quality research to better understand how these technologies can be best positioned in care delivery. In this Collection, we highlight exciting research published in Sexual Health (2020–2024) that demonstrate how digital technology and self-care can improve the client journey.

Optimising referrals to sexual health services

Digital technology has been used to help triage individuals to relevant sexual health services. A study from Sydney described an online triage tool (‘Am I OK?’) that successfully directed non-priority populations to alternative services, saving significant triage nurse time.¹ Similarly, a study reported a Chatbot-Assisted Self Assessment significantly increased intention to STI screen among minoritised ethnic groups in the United Kingdom.² For symptomatic individuals, artificial intelligence (AI) can be used to check for a potential diagnosis of mpox. A pilot study outlined the process whereby an mpox symptom checker tool was developed.³ Lessons learned include the importance of stakeholder engagement, a multidisciplinary team, focusing on the end-user, and consolidating data incrementally for building comprehensive datasets for AI tools.

Optimising the effectiveness of sexual health services

Pre-exposure prophylaxis (PrEP) for HIV scale-up globally remains slow. There is a greater role that primary care clinicians can play in improving access. A US study evaluated a mobile phone application called the PrEP Resource to improve clinician comfort and knowledge in prescribing PrEP, addressing a key barrier to its underprescription.⁴ Initial feedback showed that participating physicians found the app easy to use and comprehensive, suggesting its potential to enhance PrEP access, particularly in low-resource settings. More research is needed.

Effective partner notification (PN) is critical for STI control. A systematic review summarised the barriers and facilitators for digital PN interventions.⁵ The authors concluded that digital PN interventions should: (1) empower and support the index patient by offering multiple notification options with clear guidance; (2) seamlessly integrate into users’ existing digital habits; and (3) consider the social aspects of PN both online and offline by normalising the process, reducing STI-related stigma, and emphasising the altruistic benefits of PN through consistent communication to service users and the public.

Social media discussions about sexual health

Discussions about STIs in the community was analysed in this study which examined English-language tweets from 2019 containing the term syphilis on Twitter/X.⁶ The authors reported that the most frequent category of tweets were jokes (48%), with a smaller percentage categorised as medical resources (16%), of which 84% were medically correct. They also found that tweets sharing personal experiences had the highest engagement ratio, indicating potential for combining personal experiences with medical information for effective public health education on syphilis via social media.

Improving access to testing

Improving access to testing services is critical for the earlier detection and treatment of HIV and other STIs. This can be facilitated through self-testing technologies (including home-sampling programs) and implementing virtual STI services to reduce the need for individuals to physically attend a clinical service.

Self-testing has been successfully scaled up for several diseases (HIV, COVID-19) and has potential to be used for syphilis. The World Health Organization (WHO) launched new global recommendations to offer syphilis self-testing as an additional testing approach.⁷ In August 2024, the US Food and Drug Admisinstration authorised the first syphilis self-testing kit with results available in 15 min.⁸ A randomised controlled trial for men who have sex with men (MSM) in Zimbabwe found that syphilis self-testing increased test uptake compared to facility-based testing, with 74% versus 58% completing the tests, respectively. Despite higher testing uptake, barriers such as limited self-testing availability and poor service access remain. Consistent with findings from a systematic review,⁹ syphilis self-testing is an exciting area with potential to significantly improve testing for syphilis among at risk populations.

To maximise the benefits of HIV self-testing (HIVST), it is critical to support self-testers in the testing process and ensure that they access appropriate prevention and care. This scoping review presents a typology of the support systems for HIV self-testing.¹⁰ The authors identified diverse support approaches such as in-person, virtual, and print methods. Interestingly, the review provides data on the frequency and distribution of different of HIVST support services around the world, and emerging use of technology (e.g. Bluetooth beacons) to enhance the effectiveness of HIVST support systems.

Retesting for chlamydia 3 months post-treatment is recommended by the Australian STI guidelines.¹¹ To facilitate this, a study from Sydney, Australia reported the implementation of offering chlamydia home sampling among heterosexual males and non-sex-working females.¹² However, they reported lower uptake rates (43%) compared to a previous national trial (60%).¹³ The authors discuss practical factors (e.g. opt-in versus opt-out approaches, financial incentives) that influenced uptake rates, and underscores the need for context-specific monitoring and evaluation of home sampling STI programs. Relatedly, a study explored young women’s perceptions of self-collection for cervical screening in Australia.¹⁴ The authors reported that women valued the option due to its convenience and perceived lower invasiveness. While most participants expressed high acceptability of self-collection, they also emphasised the importance of being informed about its accuracy, the need for engagement with healthcare services, and the continued availability of clinician-collected tests.

A qualitative study from Sydney Sexual Health Centre assessed the acceptability among clients and staff of a digital testing pathway for STI screening (MyCheck).¹⁵ This platform allowed existing clients to undergo STI screening directly at pathology centres through telehealth appointments and automated pathology referrals. Overall, participants perceived the MyCheck intervention positively, highlighting benefits such as convenience, reduced burden, and improved access to testing. They also noted areas for improvement such as addressing stigma and enhancing communication with pathology providers.

In conclusion, the integration of digital technology into sexual health services offers promising opportunities to enhance the accessibility, efficiency, and inclusivity of care. The use of digital technology can transform how individuals manage their sexual health by reaching diverse populations, improving testing uptake, and supporting healthcare providers in delivering more effective services. However, the implementation of these technologies also presents challenges and potential risks that warrant careful consideration. Concerns about data privacy, the digital divide, and the accuracy and reliability of self-testing methods must be addressed to ensure equitable access and minimise potential harms. Further implementation research is needed to assess both the benefits and risks of these approaches, guiding the development of digital interventions that are not only accessible but also personalised and responsive to the needs of all individuals. The ongoing research and development in this field are crucial for navigating these complexities and achieving a balanced approach to using digital technologies and self-care to improve sexual health outcomes.