Dear Editor

Davis et al. [1] report on the recent increases in reported gonorrhoea cases and antibiotic resistance in the UK, Europe and Australia, recommending the use of new technologies and management strategies. Whilst the planned roll-out of 4cMenB vaccination is an encouraging development, early diagnosis and treatment, together with effective partner notification and testing, remain core components in reducing the burden and transmission of gonorrhoea, with the authors citing point of care testing as a means towards this.

Since 2020, Wales has had a nationally available postal self-sampling service for gonorrhoea and other sexually transmitted infections (STI) for all residents aged sixteen or over. The COVID 19 pandemic and associated restrictions forced sexual health services to limit access to face-to-face clinic appointments, so offering patients remote access to testing for sexually transmitted infections (STIs) became a priority.

The service has proved highly successful, increasing samples tested, and cases of gonorrhoea diagnosed and treated. In an estimated population for Wales of 3.2 million, 55,378 gonorrhoea tests were carried out through this service in 2021 rising to 70,673 in 2023, with the proportion of people testing positive increasing from 1.5% to 4.1% [2].

Postal self-sampling is an example of our ability in Wales, as a relatively small country, to innovate. This service was developed by Public Health Wales (PHW) and NHS Health Board Sexual and Reproductive Health Services, with permanent funding from the Welsh Government. This collaboration ensures joined-up care pathways between postal testing and clinical NHS services. Fast Track Cymru, an all-Wales network including health boards, local authorities, academics and community groups, has provided a role in raising awareness around aspects of sexual health including promoting testing in key population groups and reducing stigma.

The addition of this self-sampling service, alongside reinstated traditional clinic consultations, has had a direct impact on this disease. Recent data suggest a possible improvement in gonorrhoea trends in Wales, as positivity has fallen by over a third against a background of similar annual test request numbers (data pending publication later in June 2025). We will continue to promote this service, including working to widen access beyond online testing to community sites, to help reduce the burden and risk of gonorrhoea.

References.
1. BMJ 2025;389:r1001. doi: https://doi.org/10.1136/bmj.r1001 (Published 20 May 2025)
2. Sexual Health Trends in Wales: Annual report 2024. phw.nhs.wales/publications/publications1/sexual-health-trends-in-wales-annual-report-2024/

With acknowledgment and thanks to all sexual health services, staff involved in postal testing, diagnostics and surveillance of gonorrhoea in Wales.