Is Self-Testing for Sexually Transmitted Illness a Good Idea?
I consider myself a "do-it-yourselfer." I bought my first home, an old farm house, almost 20 years ago and have been making improvements on it ever since. I have my limitations (most notably plumbing), but, by-and-large, I try to do as much as I can myself. If a problem comes up, or some maintenence is needed, I'll research the issue a bit and then dive in to get it done. Over the years, I've done a lot that I'm proud of, but I've also made a few pretty big blunders (this is why I don't do my own plumbing anymore).
In my day job as a doctor, I've noticed increasing trends putting more autonomy in the hands of people to take care of their own health issues. The "do-it-yourselfer" and the cost-conscious part of me commends these initiatives. On the other hand, concerns arise over risks and potential harms with self diagnosis and treatment. The most recent trend I've seen is self-diagnosis of sexually transmitted illnesses (STI's).
Emerging Testing Options
A quick Google search under gonorrhea, chlamydia, trichomonas, or HIV will bring you quickly to websites for home testing. Providing a credit card payment and your address will get you a discrete kit at your doorstep. With the help of a few pictorial diagrams, a sample is easily obtained with the provided supplies. Depending on the desired test, this may be a urine specimen or it may be a swab of the cheek, vagina, or opening of the penis. Once finished, simply place the sample in an envelope, and pop the self addressed/stamped envelop in the mail. In a matter of days, the results will be available on a secure website, accessed by a code provided in the kit. Voila! The cost is much less than a doctor's visit and standard lab fee. No embarrassing human interaction is required. Is it that simple?
The Positive Implications
STI's are common. I see them routinely in my patients, and I can vouch for this. All people who are at risk should be screened. In fact, the Center for Disease Control (CDC) recommends that doctors screen ALL females aged 16-25 on a yearly basis for gonorrhea and chlamydia. The recommendation is based on myriad research, which has shown a high prevalence in this age group (no matter if sexual activity is reported or not) and a high degree of severity of untreated infection (future infertility, severe pelvic infections). As such, simplifying testing and making it anonymous for patients may increase those being tested leading to less untreated cases with adverse consequences. Further, as the government and insurance companies look to cut costs, this may offer some savings.
Some research has supported these ideas. One study looking at male testing for gonorrhea and chlamydia found increased rates of detection in those self-testing vs. doctor testing! It was hypothesized that the men did a better, more meticulous job in obtaining the specimen properly.
The Negative Implications
When I diagnose someone with an STI, a floodgate of questions open up. How did I get this? How long have I had this? Could I get this from a toilet seat? This is especially true for HIV with its myriad of implications. I give ample time to answer my patients' questions to their satisfaction and then leave them with an "open door" to ask future questions that come up.
At this point, home testing kits don't provide the interpersonal guidance that a visit to the doctor's office would. I feel this counseling is important, not only to support the patient's emotional burden, but also for the notification of the patient's sexual contacts. Encouragement should be given for the patient to make that difficult phone call to partners alerting them of exposure or transmission. Further, if the test is positive, a doctor's visit will be needed for prescription treatment in most cases. Lastly, with STI's, a cluster phenomenon definitely exists. In other words, when there is one, there is often another. Some STI's, like herpes and male human papilloma virus (HPV), are not generally tested for, but the potential and signs/symptoms should be discussed. For other potential clustered STI's, like syphilis and female HPV, standard laboratory testing is available, while home testing is not.
Home testing for STI's (or any illness for that matter) definitely has its pro's and con's. Ease of use and overall cost savings make these tests enticing. A negative test can ease the mind regarding the specific test performed. However, If a test returns positive, it's important to receive proper counseling and treatment, which can be obtained through a local physician or health department STI clinic. Also, some STI tests, are not available by this method.