Information for medical professionals

After the initial registration, a consultation with an experienced counselor from a partner checkpoint of Deutsche Aidshilfe takes place. During the consultation, it is evaluated whether s.a.m. health is the ideal service for the interested party and at what interval tests for HIV and STIs are recommended based on the individual risk of infection.

People with symptoms of an STI should – this is also part of the advice – not be tested via s.a.m. health, but are asked to visit a doctor’s practice immediately.

In the event of a reactive or positive finding, a further consultation is carried out by the partner checkpoint with referral to medical care.

The 5th generation HIV screening test is a combination test for the detection of HIV-specific antibodies and p24 antigens. In the reactive case, the results of the antibody and antigen components of the test are shown separately. The screening test detects all groups and subtypes of HIV-1 and HIV-2.

An HIV antigen antibody test should be carried out at the earliest two weeks after sexual exposure. Six weeks after the risk contact, the result is considered sufficiently reliable (diagnostic window).

In the case of a reactive screening test, a confirmatory test is mandatory: either as an immunoblot (to show various antibodies against HIV-1/2 and/or as direct virus detection by means of nucleic acid detection (NAAT, e.g. as PCR). At s.a.m health, the confirmation test is carried out from the retained sample at no additional cost to our users.

The Treponema pallidum particle agglutination test (TPPA test) is used as a screening test for people without a history of syphilis and detects both IgM and IgG antibodies. The TPPA test shows a reactive result at the earliest two to three weeks after infection. Syphilis can be ruled out after ten weeks using the TPPA test (diagnostic window).

If the findings are reactive, the patient will be referred to the doctor’s practice for a confirmatory test for Treponema pallidum IgM and IgG antibodies and for cardiolipin antibodies as markers of inflammatory activity. These complex tests require a venous blood sample – the capillary blood sample taken during s.a.m. health is not sufficient.

If syphilis is detected in the medical history during the initial consultation, a different test procedure is used in the laboratory. In these cases, the TPPA would be unsuitable as a screening test, as IgG antibodies are usually detectable in the TPPA test for life after a cure of syphilis. Recurrent syphilis can then be detected by detecting cardiolipin antibodies in the RPR test.

Detectable antibodies in the RPR test indicate syphilis requiring treatment. Cardiolipin-AK can be detected in the serum about four to six weeks after a syphilis infection.

In the event of reactive findings, users are also referred to the doctor’s practice during the consultation in order to carry out a confirmatory test for Treponema pallidum IgM and IgG-AK and another test for cardiolipin-AK (for titer control).

In the case of reinfection, IgM antibodies may be absent in the findings. Serological follow-up checks should be carried out 2-4 weeks after therapy and then at three-month intervals. A decrease in cardiolipin-AK in particular by 3-4 titer levels within one year indicates effective therapy. These treatment and progress checks are not the aim of s.a.m health’s testing services and users with a corresponding medical history are referred from the counseling service to a doctor’s practice.

Nucleic acid detection (NAAT) is a reliable and rapid way of detecting or excluding Chlamydia trachomatis (CT) and Neisseria gonorrhea (NG). Chlamydia trachomatis is the most widespread sexually transmitted bacterial pathogen. Double infections with gonococci (Neisseria gonorrhoea) occur in 10-30% of patients. Nucleic acid amplification techniques (NAAT) for CT and NG have a significantly higher sensitivity compared to culture, antigen tests and gene probe tests; in the case of NG, this applies in particular to the extragenital localizations.

In addition to the urethra and cervix, the pharynx and rectum are other possible sites of infection. CT and NG infections in the pharynx and rectum are asymptomatic or asymptomatic in >90% of infected persons, but can still be passed on. Pathogen detection in the NAAT is not dependent on its vitality.

In the case of s.a.m. health, urethral diagnosis is carried out in people with a penis using first stream urine, and in people with a vagina using a vaginal swab. Swabs are also taken from the pharynx and rectum. With regard to sensitivity, there are no significant differences between first stream urine and urethral swabs in people with a penis. In people with a vagina and uterus, vaginal and cervical smears are to be regarded as equivalent.

The samples from all three swab locations are pooled in the laboratory for better cost efficiency. Therefore, in the case of a positive finding, it is not possible to determine the localization from which the positive finding originates. However, in the case of a proven infection, the treatment is the same for all three localizations.

If a positive NG result is found, additional cultural evidence should be sought in medical practice due to the possibility of resistance testing.

The last periodic re-accreditation of the Lademannbogen laboratory commissioned by us took place in August and September 2018 by the German Accreditation Body (DAkkS). The DAkkS has been the only national accreditation body designated by the Federal Government since January 1, 2010. The current certificate according to the updated standard DIN EN ISO 15189:2014 was issued on 01.04.2019 and is valid until the standard is repealed in the specified issue status.

s.a.m health supports doctors by relieving their daily workload. The regular STI and HIV screening service empowers asymptomatic patients with a risk profile and a high level of interest in (sexual) health to manage these in a self-determined way. In the event of an infection, our users are encouraged to visit a doctor’s practice for treatment.

This allows doctors to focus more on the diagnosis of symptomatic patients and the treatment of infections detected (even earlier in the case of regular screening), while s.a.m health provides sexual health education and counseling as well as testing.

At s.a.m health, positive or reactive test results are always communicated by telephone or in person. In this case, our users will receive a text message asking them to call back or make an appointment. In this way, the colleagues in the advice centers can respond to users in a reassuring and competent manner and immediately clarify any questions that arise and alleviate widespread fears.

We also collaborate with specialist practices and refer our users to doctors for treatment if they do not have a treating doctor they can contact directly.

In the event of a serious test result (HIV), our counselors will help you make an appointment at an HIV specialist practice and accompany you to the appointment if you wish.

Do you have further questions about s.a.m health? You will find many answers in our FAQ.

If you would like to offer s.a.m. health in your practice or have further medical questions about our services, please contact Sebastian Kimmel: Sebastian.Kimmel@dah.aidshilfe.de.