Electronic Visit Use for Sexually Transmitted Infection Testing in a Large Integrated Healthcare System

Abstract Background Incorporating online testing platforms, such as electronic-visits (e-visits), into a larger healthcare system could increase access to services for persons in need of testing. A sexual e-visit was built that allows users to order laboratory-based sexually transmitted infection (STI) testing where specimen collection, result delivery, and treatment are all within the existing healthcare system. Methods We conducted a retrospective cohort study of adults in a large integrated healthcare system in Northern and Central California who completed STI testing from 13 February 2022 to 31 December 2024. We examined demographic and clinical characteristics, STI test use, and STI test positivity to assess if persons at higher STI risk utilize the e-visit. Results Among 979 557 adults, 150 128 (15%) used the e-visit to complete STI testing (median of 8822 per month). Compared to non-e-visit users, e-visit users were younger (median age in years 31 vs 37), more likely to be male (adjusted prevalence ratio [APR] 1.26, 95% confidence interval [CI] 1.24–1.27), Black (APR 1.36, CI 1.34–1.38), and more likely to have been previously diagnosed with an STI (APR 2.58, CI 2.53–2.63). Compared to non-e-visit users, e-visit users were more likely to be diagnosed with any STI after completing testing (14.7% vs 2.8%; APR 3.31, CI 3.25–3.38). Conclusions The sexual health e-visit was used by adults with increased STI risk who were more likely to be diagnosed with an STI. Though generalizability to less integrated systems may be limited, the e-visit is an effective tool to expand access to STI testing.