Impact of reduced chlamydia testing on STI testing and provider preferences in the Netherlands: an experimental...

The restrictive chlamydia testing guidelines for asymptomatic individuals at Dutch sexual health centres (SHCs) since January 2025 may influence perceptions and attitudes towards testing for sexually transmitted infections (STIs). This study aimed to assess the potential impact of this guideline change on STI testing preferences among young people and to examine determinants and underlying motivations of these preferences.

Heterosexuals aged 16-34 in the Netherlands, recruited via social media and SHCs, completed an online survey (April-June 2024). STI testing preferences (SHCs, general practitioners (GPs), commercial self-sampling tests or not testing) before and after the anticipated guideline change were assessed in a hypothetical scenario involving condomless sex with a new partner without having STI-related symptoms after. Participants initially preferring SHCs were grouped according to post-change preferences. We used logistic regression to identify factors associated with preferences and thematic analysis to explore motivations.

Of 1179 participants, 68% (95% CI 65% to 71%) initially preferred SHCs as a testing provider. After the guideline change, among this group, 24.2% (95% CI 21% to 27%) still preferred SHCs, 51.5% (95% CI 48% to 55%) switched to a preference for testing at GPs, 18% (95% CI 16% to 21%) to self-sampling and 6.2% (95% CI 5% to 8%) opted out. Switching to GPs was associated with younger age and high self-efficacy and control beliefs; choosing self-sampling with older age (>24) and university education; and opting out with inconsistent condom use and low health goals compared with preferring SHCs. Motivations included test costs, symptom absence and perceived chlamydia prevalence.

Changing chlamydia testing guidelines at SHCs may cause a shift in testing preferences to GPs or self-sampling and may discourage some from testing. These findings underscore the need for targeted communication and ongoing monitoring of STI testing behaviour to maintain STI testing uptake and are relevant for countries facing similar changes to chlamydia testing guidelines.