STI Screening During A Pandemic

[This blog post was originally published on PornHub's Sexual Wellness Center. Check it out here:] 

For this blog, I [Dr. Laurie Betito] interviewed Sarah McElroy, a Nurse Practitioner with TBD Health, a telehealth-based sexual health platform, about how Covid-19 has changed the way we think about STIs and STI screening.

Dr. Betito: thank you for joining us here at the Pornhub Sexual Wellness Center, Sarah. I’m excited to talk with you about the changing face of sexual healthcare, now that telemedicine is increasingly a frontline resource. Covid-19 has really accelerated the spread of telehealth across all areas of healthcare, as people are looking for new ways to receive care that don’t involve risking themselves to the virus. The American Medical Association reports that 46% of patients are now using telehealth to replace canceled in-person visits, up from just 11% of patients who used telehealth in 2019.

What have your patients been concerned about with regards to sexual healthcare for the last year? Are the concerns the same as they were before Covid?

Sarah: Thank you for having me. In my practice both in the clinic and with TBD Health, I’ve noticed that since the advent of Covid last March, there has been a huge positive shift in people trusting the quality of telehealth consultations. Telehealth makes a number of practical things easier for patients—it’s convenient and patients no longer have to spend time making an appointment, it’s often cheaper than in-clinic care, and it increases access to healthcare services, especially for people living in areas where healthcare providers are limited. Beyond that, there are psychological benefits too. Patients tell me it can be easier to open up to their provider over a virtual platform like Zoom, instead of sitting in a clinical or sterile setting that can feel really impersonal. I’ve noticed that often, people will come in for one thing but end up really wanting to talk about something else that they were too embarrassed to bring up. It takes a lot of trust and communication for people to open up. Especially when it comes to sexual health, being in your personal space can make you feel more comfortable and in control of the experience. There are plenty of reasons why people still need to go for an in-person visit but for things like STI screenings, telehealth is very effective and can absolutely be self-administered at home.

Dr Betito: Can you explain how at-home testing works?

Sarah: Sure. Usually, at-home testing involves purchasing a kit online. It starts like ordering anything else—you can browse different kits that test for different combinations of infections, and you can choose the one that best fits your needs/lifestyle. For instance, if you haven’t been screened in a while, a Full Panel that covers HIV and Syphilis, and Trichomoniasis in addition to Chlamydia and Gonorrhea might make sense for you. Or, maybe you have a specific interest in getting tested for Chlamydia and Gonorrhea because you had sex with someone who had symptoms. The kit gets shipped to your home in discreet packaging. Then you collect your samples. This can range from a site-specific sample (a vaginal, oral, or anal swab), a urine sample, and/or a small blood sample (if you are testing for any virus, you will need to collect a blood sample which can be collected using a finger prick), along with instructions on how to collect the sample so it doesn’t get contaminated. It takes just a few minutes to collect the samples, then you ship the samples off to a lab, and get your results within 3-5 days through an online portal. If you have a positive result, you will usually have a consultation over the phone or via video chat with a nurse practitioner or doctor who will walk you through your results and treatment plan. The entire thing is built around making patients an active part of their healthcare decisions and leveraging a form of testing that actually fits into their lifestyle.

Dr. Betito: But is it accurate and reliable? Can you tell us more about the science behind the tests?

Sarah: Yes. How the science works differs slightly based on the specific assays used by their lab, so it’s worth asking exactly how they do it or reading about it on their website. If you are thinking about at-home testing, make sure to ask. But in general, self-collected samples actually offer increased sensitivity and specificity (which are two key parameters for accuracy and reliability in lab testing). The samples are run on assays that have been around for several years at this point and whose reliability has been validated. Most tests are looking for bacterial presence or anti-bodies/ antigens in the case of viruses. If the sample is reactive or shows an infection is detected, then the lab will confirm that result by re-testing the sample to reduce the chances of a false-positive result. It’s really important that people know that no test is infallible—there is no such thing as a perfect track record when it comes to positives and negatives—and any reputable lab will admit as much and will be upfront about their error rates.

Dr. Betito: Is at-home testing for STIs similar to at-home testing for Covid-19?

Sarah: What’s been really interesting is that the protocols around preventing Covid-19 transmission are very similar to what we should be doing for STIs. In the discussions we’ve all been having around Covid, we have had to ask the people in our lives questions like “can you please wear a mask?” and “when were you last tested?” and “were you exposed to anyone recently?” These questions help us stay safe and also help us maintain respectful boundaries so we don’t risk infecting others. And really, these questions are very similar to the questions we should be asking our sexual partners when it comes to STI status! My hope is that Covid-19 has trained everyone to get comfortable asking questions like “can you please wear a condom?” and “when were you last tested for STIs?” and “who else have you been with since me and have you been tested since then?” STIs have been increasing steadily for the past 6 years (note: the CDC released a report last week saying that STIs are at an all-time high for the 6th year in a row), and if we don’t do something to curb them, they will be the secondary pandemic that hits us just as we are starting to see some relief from Covid-19. We need to reframe the conversation around preventing STIs to be one about taking care of each other: “I’m protecting your health, as well as my own. Thank you for doing the same for me.”

Dr. Betito: How do you think peoples’ STI testing habits will change now that vaccinations are increasing and people get increasingly more comfortable with dating again?

Sarah: I think telemedicine is here to stay. More and more people will adopt at-home testing as their preferred way to stay up to date with their sexual status, simply because they are more educated about how reliable it is and because it’s so much easier to incorporate into your life than having to make appointments and deal with the rigmarole of insurance. My hope is that at-home testing makes it easier for people to get tested more frequently than they were before, because people were not getting tested frequently enough.

After a year of not being able to date freely, I think people will want to make up for lost time! We are about to see a rampant explosion in sexual activity, likely with more sexual partners than average. And we know from the CDC that rates of infections are ever-increasing, so now is the time to get smart about having a testing routine. People don’t realize that getting tested is super important for protecting you from long-term consequences like infertility and even cancer. Get busy and have sex, by all means! Just be smart about it.