UAB Medicine News
Home STD Tests are Convenient, but There are Drawbacks
Seeing a health care provider usually is the most reliable way to determine if you have a sexually transmitted disease (STD). In some cases, home testing for STDs provides a convenient or necessary alternative, but it may come with some drawbacks.
The Centers for Disease Control and Prevention (CDC) says that of the nearly 20 million estimated new STD infections each year, about half of them are among young people age 15 to 24. The most recent CDC surveys show large surges from 2014 to 2018 in cases of gonorrhea, chlamydia, primary and secondary syphilis, and congenital syphilis.
Some STDs do not cause symptoms – or the symptoms are barely noticeable – so many infected people don’t know they need treatment. If left untreated, though, STDs can lead to severe health complications such as pelvic inflammatory disease, increased risk for HIV, certain cancers, and infertility.
Because the number of infections and need for screening have increased, at-home test kits for STDs such as HIV, chlamydia, and gonorrhea have grown in popularity. Visiting a clinic is the best choice for screening, but if privacy concerns, inconvenience, or limited access to a provider are issues, then online and home-to-lab STD screening tests may be a good option.
Home STD testing kits can be ordered online or purchased at a pharmacy. The kits require an oral or genital swab or the collection of a urine or blood sample (or both), which then go to a laboratory for analysis. Results are returned by phone, through the mail, or published anonymously and securely online. Prices range from $40 to a few hundred dollars.
Pros and Cons
UAB Medicine obstetrician and gynecologist Shweta Patel, MD, says home testing may be a good option in certain cases.
“Some people may have limited transportation and can’t get to a clinic easily, so the kits do offer convenience,” Dr. Patel says. “These screenings do not require a pelvic examination, therefore people with medical conditions that can make pelvic exams difficult have the option of testing at home. There is also, unfortunately, still some stigma attached to screening, so the home test offers some level of privacy for those who are reluctant to visit their doctor or go to a screening clinic.”
The tests themselves seem reliable enough, Dr. Patel says, but the concern is that people testing at home may not be collecting a good sample to send the labs.
“Accuracy is essential, and accuracy in home tests for STDs is dependent on the collection process,” Dr. Patel says. “The HIV, hepatitis C, or syphilis tests require a blood sample, so a finger prick should provide an adequate sample. However, most tests for chlamydia and gonorrhea require vaginal swabs or urine samples. As a provider, knowing from my practice what is sometimes needed to get an adequate swab sample, I do wonder if people are accomplishing that task at home.”
Dr. Patel says there other concerns, such as how well regulated the lab facilities are, and whether test makers offer information about what kind of analysis their labs use. Tests may get false positive results, showing the presence of an infection where there is not one. A more serious possibility is a false negative result, in which an infection is present but goes undetected.
“A false negative result means that the undiagnosed STD will probably go untreated,” Dr. Patel says. “These infections can lead to serious conditions such as infertility, ectopic pregnancy, cervical cancer, or infections in infants born to infected mothers. Individuals using online testing should look for plenty of information about the laboratory that does the analysis. There tends to be more scrutiny of the analysis process in a hospital clinic, medical system, or in labs recommended by a state or national health department.”
After the Results Are In
Dr. Patel suggests that another potential drawback with home STD testing is how patients respond to results after they receive them. A positive result can be alarming and confusing, so patients may not correctly interpret their test results. Speaking with an informed provider can help patients better understand the infection and provide guidance about treatment, disclosure to sexual partners, and how often to get re-tested. Although some home testing labs and websites offer advice by phone or provide links to local doctors for treatment, overall they do not give the same level of post-diagnosis care that in-person visits can provide, Dr. Patel says.
Surveys of women between 15 and 24 years old – a high-risk group for STDs and their long-term effects – show that home testing has increased for this group in recent years. About one-third of those surveyed who used a home test kit reported that they did not get counseling from a health care provider after receiving test results.
“The group of sexually active people who are most likely to use a self-testing kit overlaps with the group who most need the counseling that goes with positive results,” Dr. Patel says. “There’s a lot that goes into that discussion, especially among the younger population. They need to know how to go forward with confidence when it comes to treatment, prevention, recognizing symptoms, or asking a partner to get tested. The advantage of getting tested at your doctor's office or a clinic is that consultation and treatment are immediately available.”
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