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The term ‘sexually transmitted diseases’ covers a wide range of infections and viruses. The best known include:
Long-term outcomes depend upon the illness and range from pelvic inflammatory disease leading to infertility and other conditions, to death in the case of HIV/AIDS.
With many diseases transmissible through sex, testing for STDs is critically important. While it cannot prevent a person from getting a disease it can stop them from spreading it, and can also protect against the serious health consequences that can come from untreated infections.
Unfortunately, people resist getting tested for STDs. Despite changing attitudes about sex and social acceptance to discussions about contraception and abortion, there is a persistent taboo that surrounds sexually transmitted diseases.
“What makes this especially surprising is that S.T.I.s are so ubiquitous,” says Dr. Jen Gunter, an obstetrician and gynecologist practicing in California and the author of “The Vagina Bible.” “Consider that 50% of sexually active people will have at least one S.T. I. by age 25 (HPV is the most common) and there are over 110 million new and existing S.T. I. cases each year in the United States.” She explains that public shame and stigma have been attached to STDs for centuries, and that those who have them “can be falsely labeled promiscuous or dirty …. or both.”
In addition to stigma there are barriers that exist in all aspects of our current healthcare system: Cost and access.
While the most rigorous approach to testing for STDs is regular screenings in combination with health check-ups, the introduction of at-home testing has been a game-changer. Having the ability to purchase an at-home test that is self-administered, and whose results are delivered quickly and confidentially, eliminates the anxiety and embarrassment — as well as the issues of access — that have held many back from seeking a test at a doctor’s office or clinic.
The National Coalition of STD Directors (NCSDDC) recently issued a statement regarding at-home self-collection of lab testing for sexually transmitted infections: “Home-based sample collection for lab-based testing allows collection of objective data to facilitate patient care without the patient having to leave home. Sample collection at home is straightforward and safe, validated to ensure accuracy consistent with traditional lab testing, and provides patients with an enhanced sense of privacy.”
That sense of privacy eliminates what Dr. Gunter refers to as the “stigmatizing interactions with health care professionals” that can lead to people being “less likely to be screened, treated and get the care that can prevent infections and save lives.”
Some patients prefer the simplicity, security, and privacy of collecting specimens at home. And testing at home eliminates the anxiety and fear some patients might have about clinical testing visits.
If you’re following collection instructions carefully, you can trust the accuracy of your at-home STD test.
The diagnostic assays that are most frequently used to test for sexually transmitted infections are either cleared by either the Food and Drug Administration or subject to “premarket approval.” However,, self-collection of samples is not.
Many at-home STD tests fall into the category of Laboratory Developed Tests (LDTs) rather than FDA-approved but are still required to meet the quality standards for laboratory testing established by the Clinical Laboratory Improvement Amendments of 1988. Many of the at-home tests provide accuracy that the NCSDDC says are “fully validated with sensitivities and specificities near 100%,” but also provide back-end services including patient support.
The top concerns about the accuracy of at-home STD tests surround the issues of collection methods rather than the laboratory processes. Consumers who are seeking at-home tests should specifically look for tests that examine samples with labs that meet the standards of the Clinical Laboratory Improvement Amendments. The tests themselves should be FDA-approved, though an at-home collection will not have an FDA indication. It is up to the patient to follow the instructions for at-home collection and proper packaging.
If the tests are FDA-approved, it makes little difference where it is collected, says John Papp, a microbiologist in the CDC’s Division of STD Prevention. “If the specimen is collected properly, regardless of the setting, the test is probably being performed adequately.” Most tests are looking for either the antibodies or a combination of the antibodies and the disease.
One essential aspect of getting accurate results for at-home STD testing is to time the test correctly. Different sexually transmitted infections have different incubation periods. If you regularly have unprotected sex, you should test intermittently, on a regular schedule. If you’re concerned about your health after having sex with a particular partner or following a specific encounter, understand that testing too soon will not give you the answer you need.
While seven days may represent a sufficient passage of time for chlamydia and gonorrhea, HIV and herpes will require a minimum of three months before a test will provide truly accurate results. Most at-home testing companies provide time frames for testing and retesting, and these should be adhered to closely.
Though at-home tests provide privacy and avoid the embarrassment that can come from seeking an in-person test, a positive result requires intervention. Retesting will be required – especially as there are some tests that deliver false positives – but immediate treatment is important, not only to prevent long-term consequences of untreated disease but also to stop further transmission.