As a practicing OB-GYN and Medical Director at Hologic, Dr. Kyle Bukowski is focused on improving women’s health through preventive care and early detection of many medical conditions, including sexually transmitted infections (STIs).

STIs are on the rise in many parts of the world, with more than 1 million curable infections acquired every day in people 15-49 years old.¹ One reason could be a recent decline in condom use, according to Dr. Bukowski: “With the availability of long-term contraceptive options, among many other factors, I think we’re seeing less condom use — so education around condoms and their benefits is very important.”

While STI rates climb, the number of people being tested for them remains low, especially since most of these infections don’t cause any symptoms. According to Hologic’s Global Women’s Health Index, just 10% of women reported being tested for any type of STI in the past year. Untreated STIs can lead to a condition called pelvic inflammatory disease, which can cause chronic pain and infertility in women. For pregnant women and their babies, these infections can contribute to serious complications such as birth defects, premature birth, stillbirth and transmission of the infection across the placenta, underscoring the need for timely and accurate testing.

What is “opt-out” screening?

With the commonly perceived stigma surrounding STIs, it’s not surprising that many patients skip testing during their regular wellness visits. That’s where opt-out screening comes in, according to Dr. Bukowski.

“Opt-out screening is about normalizing universal testing and shifting the dialogue from, ‘Do you want to be screened today?’ to informing patients that a test will be performed unless they actively want to decline it. It removes the pressure from the patient to have to self-assess their individual risk,” said Dr. Bukowski, adding that he’s seen screening improve in settings where this approach has been adopted, such as emergency room visits and prenatal care.

Opt-out screening for infections like chlamydia and gonorrhea seems to be working where it’s being implemented, but its success is heavily contingent on patients keeping their wellness appointments, which can be a hurdle in itself.

“We know that cost, time away from work, transportation and other barriers around accessing healthcare remain challenges,” said Dr. Bukowski, noting the decrease in preventive screenings pre-pandemic that worsened dramatically during COVID-19 due to appointment availability and a hesitancy to visit healthcare settings. “I think we’re going to continue to see the impacts of that for at least the next five years.”

Among young people, who make up the largest percentage of new STI infections, Dr. Bukowski says education and the presence of a trusted adult — whether it’s a doctor, a parent or another family member — to talk to about their sexual health and screening options are critical.

One swab, multiple results

Patients may also be concerned about discomfort during the test itself. According to Dr. Bukowski, education around the latest testing technologies available can help. Scientific advancements — such as Hologic’s Aptima^® Multitest Swab that can be used to detect gonorrhea, chlamydia and many other infections with a single vaginal swab — can make the testing process faster and easier for both providers and patients while offering a high degree of accuracy.

“The benefit of nucleic acid amplification testing (NAAT), which is what Aptima assays use, is that you only need a very small amount of material to detect an infection,” said Dr. Bukowski. “That’s because we’re targeting RNA, which can have more ‘copies’ than DNA available to detect an organism. This is critical for tests like the Mycoplasma genitalium assay because the organism we’re looking for has such a small amount of DNA.”

With antibiotic resistance growing, a timely and accurate diagnosis is paramount

The emergence of multi-drug resistant STIs is causing a treatment crisis globally, and although pharmaceutical companies continue to introduce new drugs, they are primarily based on decade-old discoveries.²

“Chlamydia and syphilis remain very sensitive to even our oldest antibiotics, but infections like gonorrhea and Mycoplasma genitalium have found many ways to mutate and avoid being responsive to these treatments,” said Dr. Bukowski, citing that the first piece of the puzzle is knowing an infection is present.

“Testing is critical because the antibiotic you’re getting for your dental procedure or respiratory infection could be increasing the resistance to another asymptomatic infection like gonorrhea you don’t even know you have.”

The second piece is ensuring treatments are working, so depending on the infection, a patient may be re-tested three months after the initial antibiotic course. With advancements in science, companies like Hologic are exploring ways to curb antibiotic failure before it happens.

“At Hologic, we’re exploring new technology that could identify resistant organisms that have evolved immunity to one or more drugs used to kill them,” said Dr. Bukowski. “This has the potential to help clinicians make the right treatment choice out the gate, or, if a drug isn’t working, we can know that sooner and adjust the treatment for that patient.”

Open dialogue remains key

While screening methods and treatments for various STIs continue to advance, the stigma surrounding them remains a substantial challenge to ensuring people receive timely and accurate testing.

For Dr. Bukowski, the solution for this is simple: “Have the conversation — whether it’s with your doctor about screening recommendations, a family member to educate them on how to minimize their risk or a partner to understand their testing history. By normalizing the discussion around STIs as a key part of overall health, we can combat the spread of these infections and help millions of patients get the treatment they need, sooner.”