What Doctors Think of At-Home STI Tests

What Doctors Think of At-Home STI Tests

Across the United States, rates of sexually transmitted infections are on the rise. Diagnoses for chlamydia, gonorrhea, and syphilis have all risen dramatically over the past several years, according to the Centers for Disease Control and Prevention’s most recent surveillance report.

“Not that long ago, gonorrhea rates were at historic lows, syphilis was close to elimination, and we were able to point to advances in STD prevention,” wrote Gail Bolan, the CDC director of STI prevention, in the report’s intro. “That progress has since unraveled.” Lack of health care access and weakened public health infrastructure, she wrote, have been two of the main drivers allowing these diseases, once relatively under control, to flourish.

Of course, one of the best mechanisms we have for keeping STIs under control is regular testing. But if you’ve ever had an STI test, you know how stressful the situation can be: the squirminess of discussing intimate details (and intimate body parts) with strangers, the worry that comes with waiting for your results, the anxiety at the prospect of having some tough conversations if anything comes back positive. Regardless of whether you’ve popped into a clinic or are being tested by your trusted doctor, the experience isn’t a pleasant one.

Recently, a few companies have tried to solve that problem by selling at-home STI testing kits that customers can use to screen themselves for some of the most common diseases. There are currently dozens of brands, and their kits are available over the counter at a drugstore or online. Customers collect samples of urine, saliva, or blood; send them off to labs; and receive their results over the phone or through a linked app. In the growing — and controversial — market of direct-to-consumer medical tests, the STI kit occupies a unique niche: a tool for personal health that’s inextricably linked to a larger public health issue.

As these kits have become more common, so have first-person reviews: A quick online search yields plenty of “I tried it” articles evaluating the products from a user’s perspective. And for would-be patients turned customers, the perks do seem obvious: privacy, convenience, the comfort of your own home. But for some in the medical community, the perspective is a little more nuanced. These kits have their benefits and may even be an overall net positive in getting the spread of STIs under control, but they also have their problems — some that apply to at-home medical tests more broadly, and some specific to the world of sexual health, with all the health care barriers, myths, and stigmas contained therein.

More than a “disruption” of the STI testing status quo, the rise of at-home testing feels like a natural progression of sexual wellness technology, says Stephanie McClellan, MD, medical director at the Tia Clinic in New York City. “I’ve been practicing medicine long enough to remember a time where doctors didn’t know if women should test for yeast infections at home, or whether they should take at-home pregnancy tests,” she says. “This, in my mind, is just an iteration of this slowly moving train to allowing people to have bodily autonomy that they want and deserve but providing it in a context that’s medically safe.”

In a country where sexual health funding is being dramatically cut, having more immediate access to testing — as opposed to, say, having to drive a county over to the nearest clinic — can make a vital difference. “Being able to know as soon as possible that someone is testing positive for chlamydia, for example, is a good thing,” says Kristyn Brandi, MD, MPH, assistant professor at Rutgers New Jersey Medical School and a board member with Physicians for Reproductive Health. “There’s huge value in being able to access care, especially in rural areas or in states where clinics aren’t readily available. It creates opportunity to intervene earlier.”

And the earlier you intervene, the earlier you can start to treat, which can help cut off the spread of disease. “A lot of people refrain from testing because of the fear of the results and the fear of stigmatization,” says Robert Segal, MD, co-founder of LabFinder.com, which helps people locate nearby medical testing sites. “If they’re testing at home, it might help to relieve that fear, which can lead to a greater incident of treatment.”

On the other hand, that fear of stigmatization can also keep people from seeking treatment, McClellan notes, which is one area where at-home tests can fall short. When a doctor diagnoses a patient with an STI, that doctor is then required by law to report it to the CDC and implement a treatment plan. But if the patient is getting these results outside of an office, there may be little motivation to seek out a doctor and get treatment.

Still, McClellan says that this fear of folks slipping through the cracks, while valid, is ultimately moot. “If people are fearful, or they don’t have the resources, they aren’t going to be screened anywhere,” she says. “That’s why these diseases are currently on the rise.”

And while doctors are all in near agreement about the need for more access to medical data, they are also quick to point out the potential scientific pitfalls of these at-home tests. In theory, they’re fairly simple to perform: Just collect your sample — by swabbing your mouth or genitals, peeing in a cup, or sticking your finger for blood — and seal it to send away for analysis. Unfortunately, because most of the people giving themselves these tests are not trained medical professionals, user error can introduce problems.

“At-home testing can show false negatives as often as one in 12 times,” Segal says, which could lead someone with an infection to participate in behavior that could spread the disease. “So, ideally, these at-home kits would be more sensitive than the ones we have in the lab, because they need to be. Even if it’s picking up a false positive, that’s a preferable situation, because then a patient can go into the offices and get a second opinion.”

Most patients also don’t know their STI timelines: Some infections, like chlamydia and gonorrhea, can show up just a few days after exposure, while infections like herpes and HIV can have an incubation period of up to three months. “If the patient tests too early for these infections, they could get a negative result, when in reality, they’ve just tested too early,” Segal says.

Consultation is also a necessary part of STI testing and a factor that some of these kits may provide an abbreviated version of. Some companies have a member of their team call the patient in the event of a positive result, but doctors like Brandi worry if that’s enough. “Some folks might get a positive result from one of these at-home test, and then they’re stranded,” she says. “In the office, I can talk to them about what that means.” Brandi also says that even in the event of a negative test result, she will still discuss risk factors that could cause them to test positive in the future. “Regardless of test results, I believe people should have a consultation.”

Another issue with home tests is pricing: They can run anywhere from $30 to 200, but unlike in-office testing, they aren’t covered by insurance (though some are FSA eligible, meaning that the patient can use their flexible spending account to pay for them). “That’s great for folks who are not insured or who are underinsured,” Brandi says. “But it seems silly to me for [insured] patients to go pay for things that are covered by insurance.” This wrinkle is amplified if you consider the fact that most doctors suggest getting tested every six months.

All of these caveats aside, the doctors and health professionals interviewed for this story agreed that, in the end, the positives outweigh the negatives. “My clinical opinion is that I’d rather come down on the side of people screening themselves… so that people do seek treatment,” McClellan says. “It’s empowering, because it allows people to move away from the stigma of shame associated with STIs. It normalizes testing, which can help keep the spread of infection down.” And in the end, it’s certainly better than no testing at all.

What Doctors Think of At-Home STI Tests

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