On July 1, 2025, France took a historic step in the fight against sexually transmitted infections (STIs). Assurance Maladie, the national health insurance system, introduced a free nationwide self-collection program (Mon test IST) to strengthen STI screening . This program allows women aged 18–25 to order a vaginal self-collection kit for testing for chlamydia (CT) and gonorrhea (NG) through a dedicated website.
This initiative tackles a growing public health concern: the rise of gonorrhea and chlamydia cases across Europe, especially among young adults. For healthcare professionals, the program represents a new model for expanding STI screening to address infections that are frequently silent but can lead to severe long-term consequences, including infertility and pregnancy complications. It also marks a cultural shift by promoting home testing kits for STIs in reducing stigma and increasing accessibility to STI screening.
Understanding Gonorrhea: A Resurgent Threat
Gonorrhea, caused by Neisseria gonorrhoeae, is a highly transmissible bacterial STI that can spread through vaginal, anal, and oral sex. Although it can cause symptoms like urethritis, abnormal vaginal discharge, or pelvic pain, many cases – especially in women – remain asymptomatic, underscoring the importance of proactive STI screening.
In Europe, the ECDC reported that gonorrhea cases rose by 31% in 2023, and since 2014, the incidence has risen by over 300%, with the highest rates among young adults aged 20–24, a group that is often sexually active but less likely to get regular screenings. Globally, the WHO estimates more than 82 million new cases each year. For clinicians, gonorrhea is particularly concerning because of antimicrobial resistance (AMR). The development of resistance to first-line treatments raises the risk of untreatable gonorrhea, making early detection through effective STI screening and prompt treatment crucial –both for individual patients and for public health efforts to reduce transmission.
Understanding Chlamydia: Europe’s Most Common STI
Chlamydia trachomatis is the most reported bacterial STI worldwide, and Europe is no exception. According to surveillance data, over 230,000 new chlamydia cases were confirmed across the continent in the past year. Young women aged 18–25 represent the highest-risk group, highlighting the need for targeted STI screening strategies.
Up to 70% of women and 50% of men have no signs of infection, which means the disease often spreads without systematic STI screening. When symptoms do occur, they may include mild dysuria or vaginal discharge—signs that are often overlooked.
The long-term effects of untreated chlamydia are well-known: pelvic inflammatory disease, tubal factor infertility, chronic pelvic pain, and ectopic pregnancy. These outcomes emphasize the importance of regular STI screening. That’s why clinicians often stress how STI screenings are performed and encourage patients to get tested even if they have no symptoms.
Silent Infections: a Hidden Danger
Both gonorrhea and chlamydia are often called “silent infections” because they typically lack symptoms. This silence means patients rarely seek care early, allowing the infections, without adequate STI screening, to spread in communities. Clinically, this is really risky; by the time complications like infertility or ectopic pregnancy develop, irreversible damage may have already occurred.
Another challenge is the stigma surrounding STIs. Young people often hesitate to visit STI testing clinics out of fear of judgment, prompting them to search online for information on how to do an STI test at home, how quickly they can get results, or how to check themselves discreetly. Until recently, the French healthcare system had few solutions to these concerns. The new Mon test IST program addresses both issues: it reduces stigma by allowing discreet self-collection at home, and it accelerates diagnosis by offering free, accessible STI screening to the most affected age groups.
Diagnosis: From Clinics to Self-Collection
Nucleic acid amplification tests (NAATs) are the gold standard for STI screening for both chlamydia and gonorrhea. They are very sensitive, adaptable to different sample types, and generally deliver results within 24 to 72 hours. However, patients mainly care about how STI testing is done, how to get tested discreetly, and how quickly they can get results.
Traditional STI testing typically requires patients to visit a clinic, undergo sampling, and wait several days for results. For women, this means a vaginal swab collected by a healthcare provider, while men might have a urethral swab or urine test. These methods are accurate but often discourage young people from seeking care, limiting participation in routine STI screening.
Home testing kits for STIs are a major breakthrough in expanding STI screening coverage. With self-collected vaginal swabs, women can now collect samples privately, following instructions provided by professionals. The sample is mailed to a certified lab, where it undergoes the same NAAT testing used for clinic samples. The main difference is accessibility and comfort: patients no longer need to visit a clinic, and healthcare professionals can reach groups that previously avoided STI screening.
The French Program: A National Strategy for Prevention
The Mon test IST initiative is unique in Europe because it is the first national, publicly funded STI screening program. All women aged 18–25, regardless of insurance status or location, can request a free self-collection kit through the official website. The kit includes a Copan FLOQSwabs vaginal self-collection device, detailed instructions, and prepaid shipping for sample return.
Video tutorials on the website explain step by step how to perform the sampling at home and reassure users about the simplicity and safety of the procedure. Once the sample is analyzed, results are delivered securely and discreetly. For women who test positive, the program provides rapid linkage to care through their healthcare provider, ensuring timely treatment and follow-up within the national STI screening framework.
Beyond the kits themselves, the program is part of a broader prevention strategy. Regional health agencies promote awareness campaigns in universities and community centers, while mobile projects such as “Mes Tips Santé” buses bring information and support directly to young people in underserved areas. This integrated approach reflects the recognition that tackling STIs requires not only diagnostics but also education and the reduction of stigma. Looking at healthcare professionals, the program offers both opportunities and responsibilities. It enables clinicians to reach patients who would otherwise remain undiagnosed, but it also requires adaptation in terms of counseling, follow-up, and integration into existing existing STI screening pathways. Clinicians should actively inform patients about the availability of self-collection, emphasize the importance of regular STI screening, and provide evidence-based treatment when results are positive.
The European Context: Self-Collection in the spotlight
France is not alone in adopting self-collection for STI screening. In the United Kingdom, postal STI testing services have been available for years, especially in urban areas. The Netherlands and Scandinavian countries also offer online systems for home kits. However, most of these services are regional or rely on local funding. France is the first country to deploy a nationally coordinated, insurance-funded STI screening program. The scale of this implementation is crucial because it ensures equal access, establishes consistent standards for laboratory testing, and provides population-level data to inform public health policies. For the ECDC, such initiatives match recommendations to increase access to discreet, stigma-free STI screening and to integrate home-based options into broader surveillance systems.
Conclusions
The rise of chlamydia and gonorrhea across Europe highlights the urgent need for innovative innovative STI screening strategies. With the launch of Mon test IST, France has become a leader in making STI self-collection a widely accepted, publicly supported component of national STI screening. By combining medical accuracy with accessibility, France’s program sets a standard for other countries. For young women, this means the ability to access STI screening at home, get quick and reliable results, and protect their reproductive health without stigma. For healthcare professionals, it provides a new tool to improve early diagnosis, prevent complications, and stop the spread of infections that continue to challenge European health systems.
Resources
- https://mon-test-ist.ameli.fr/
- https://www.ecdc.europa.eu/en/news-events/sti-cases-continue-rise-across-europe
- https://www.ecdc.europa.eu/sites/default/files/documents/Syst-review-prevalence-stis.pdf
- https://www.lemonde.fr/sante/article/2025/06/30/l-assurance-maladie-lance-un-kit-de-depistage-gratuit-pour-les-18-25-ans-afin-de-lutter-contre-la-hausse-des-infections-sexuelles_6616978_1651302.html
- https://vih.org/vih-et-sante-sexuelle/20250730/mon-test-ist-en-ligne-lauto-prelevement-a-domicile-pour-le-depistage-chlamydia-gonocoque/
- https://francais.medscape.com/voirarticle/3613074?form=fpf
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