Home-collection Testing for Sexually-transmitted Infections

The U.S. Preventive Services Task Force recommends that all sexually active females 25 years of age and younger as well as all other sexually active women who are at increased risk for infection should be tested each year for chlamydia and gonorrhea. Positive test results require follow up for treatment with antibiotic drugs. More than 1.5 million cases of chlamydia and gonorrhea were reported in 2008, according to the U.S. Centers for Disease Control and Prevention (CDC), but that number represents only about half of existing cases. The CDC estimates that only about 26% to 60% of women actually get recommended annual screening. Testing scenarios that are easier for women might boost this figure.

Currently, unlike home pregnancy tests, there are no testing kits sold directly to consumers that allow people to test for these infections and get results at home, nor are there home-collection kits like those approved by the FDA for HIV testing in which the sample can be collected at home and sent to a laboratory for testing without a doctor's order. Web-based, physician-directed testing services, however, are available for STIs.

The U.S. National Institutes of Health funded the research led by Jeffrey Peipert, MD, professor of obstetrics and gynecology at Washington University in St. Louis. Published in the April issue of Obstetrics and Gynecology, the study of St. Louis-area women found that when given the option of taking an at-home test for these STIs, 76% of 462 women of mean age 25 would prefer this choice over sample collection at a clinic or their doctors' offices. The proportion of women who preferred these two options were 16% and 8%, respectively. Those who preferred home-based testing were more likely to get screened than those who preferred clinic-based testing, 64.6% versus 31.6%, respectively.

Overall, 56.6% of total participants completed screening during the study. Women who used home-collection tests used vaginal swabs to obtain smears and then mailed them to a lab. These women reported that the test was easy to perform, and results were comparable to results of regular screenings, the researchers report.

"Future interventions to increase screening rates in young women should consider alternative screening strategies such as home-based or patient-controlled testing," the researchers write. The screening rate in their study is roughly similar to previously reported chlamydia screening rates in young, sexually active U.S. women, writes Diane J. Angelini, EdD, CNM, in the May 6 issue of Journal Watch Women's Health. "However, the results [in the current study] show that women view home-based specimen collection positively and that this acceptance is associated with better screening rates than is clinic-based screening," Angelini adds. While predicting that home collection would afford women greater privacy and improve STI screening rates, she emphasizes that it cannot replace periodic gynecologic examinations.

Dr. Cynthia Krause of Mount Sinai Medical Center in New York City expressed similar concerns in a March 30 Healthday news article. "I think that anything that increases testing for STIs in young women is valuable," she said. "But, as a GYN, I worry that it will lead to women having less of a relationship with a doctor and possibly feeling that a test is a replacement for a visit with their GYN."

If women were to choose home-based screening for chlamydia and gonorrhea, they would still need to visit their health care providers for other important testing, such as screening for hepatitis, human papilloma virus (HPV), as well as Pap smears. In addition, this information is based on a study conducted in a research setting. The study did not address the many practical matters involved in implementing this type of testing, such as how test kits would be distributed and then returned for testing, how results would be reported, and perhaps most importantly how women would be able to follow up and get needed treatment after a positive test result.

Diane J. Angelini. Home-Based Screening for Sexually Transmitted Infections. Journal Watch Women's Health. Available online at http://womens-health.jwatch.org/cgi/content/full/2010/506/2?q=etoc_jwwomen through http://womens-health.jwatch.org. Published March 6, 2010. Accessed June 1, 2010.

Ellin Hollahan. Women Would Welcome At-Home Test for STDs. HealthDay. Available online at http://www.medicinenet.com/script/main/art.asp?articlekey=114883 through http://www.medicinenet.com. Published March 30, 2010. Accessed June 1, 2010.