July 10, 2019 at 06:30AM by CWC
Raise your hand if this scenario is familiar: You’ve asked to be tested for sexually-transmitted infections (STIs), and your doctor responds with a few intimate questions about your behavior in the bedroom. You want to tell the truth because you know it’s important, but you’re embarrassed or ashamed or anxious, so you lie. (Anal? Little ol’ me? Why I never!) As a result, your doc runs the mildest of STI panels—urine, possibly a vaginal swab—and calls it a day.
If your hand is in the air, you’re not alone: STI rates nationally are on the rise (reported cases of syphilis, gonorrhea, and chlamydia combined are at their highest levels in two decades), yet experts say that people aren’t getting tested as they should. There are lots of barriers that keep people from getting tested, from lack of awareness about risk to enduring stigma that makes it hard for patients to be open with their doctors about their behaviors.
That’s why virtual healthcare company Nurx (which is best known for its online birth control, emergency contraception, and HIV PReP services) is launching a bevy of at-home STI tests today that can be ordered online and administered in privacy. The tests offerings include: The Full Control Kit, which tests for gonorrhea and chlamydia (throat, rectal, urine swabs), syphilis, hepatitis C, and HIV (blood sample), and is $75 with insurance or $220 without; The Healthy Woman’s Kit, which tests for gonorrhea and chlamydia (throat and vaginal swabs), trichomoniasis (vaginal swabs), syphilis and HIV (blood samples) and is $75 with insurance or $190 without; The Covered With the Basics Kit, which tests for gonorrhea and chlamydia (urine sample), syphilis and HIV (blood sample) and is $75 with health insurance or $150 without. The goal is to make STI testing easier, more affordable, and with fewer awkward face-to-face interactions with a potentially judgmental lab tech or doctor. The tests are available in 24 states and the District of Columbia.
While medical experts can often be skeptical about at-home health tests in general (and Nurx itself has recently come under fire for some of its past practices) in the case of STI screening, OB/GYNS are on-board with the idea. “[At-home STI tests] can provide a more rapid access to testing and in some cases may save money,” says Felice Gersh, M.D., OB/GYN and founder/director of the Integrative Medical Group of Irvine, CA. “[They are] an excellent option.”
How it works: A patient fills out an online form answering questions about their health and sexual history. A Nurx practitioner then reviews their answers and connects with them to help the patient choose the right STI test. Nurx ships the STI testing kit to the patient, and they follow the enclosed directions to complete it at home. They send back their samples to a Nurx partner lab for processing. Within a week, a Nurx practitioner will contact the patient over the phone or through an online chat to help them understand their results and next steps for treatment, if necessary. Their labs accept some major insurance plans, including BlueCross BlueShield.
If tests for the throat and rectum seem extreme, Nurx’s clinical development lead and nurse practitioner Emily Rymland, NP, offers a cautionary tidbit. “Here’s the deal: We have oral sex, and some of us have anal sex, and unless you swab those sites you’re not going to find the infection,” she explains. “If you have it in your throat, it’s not going to test [positive] in the urine.” She insists collecting these samples is NBD—a couple of quick, not-too-invasive swabs.
“There’s a lot of discomfort with providers around talking about sex with women, so this is the way to allow women to test freely without stigma.” —Emily Rymland, NP, clinical development lead at Nurx
As for how these six specific infections were selected for testing, Rymland says that gonorrhea, chlamydia, and syphilis can be asymptomatic, meaning you can spread it without realizing it. “Plus, women who have chlamydia or gonorrhea who don’t get treated can end up with infertility because it [can cause] scarring in the fallopian tubes.” Syphilis can likewise be symptomless and therefore go untreated for years and “actually fry your brain,” she tells me. (Basically, it can spread to the brain and nervous system and cause blindness, paralysis, and even dementia.) Meanwhile, trichomoniasis, an STI caused by parasites, is included because “it’s a really common infection in women,” Rymland says. It’s easy to test and easy to treat, says Rymland, and catching it early can help prevent pelvic inflammatory disease. And while Hepatitis C is more difficult to contract than these others, the test is included as an option nonetheless (IV drug users are at an increased risk, she notes).
For HIV, the Centers for Disease Control and Prevention (CDC) recommends that all people aged 13 to 64 should be screened at least once in their lifetimes. People who fit a certain list of risk criteria—like men having sex with men, having more than one partner since your last HIV test, or having been diagnosed or treated for another STI—are recommended to get tested at least once a year. Not every sexually active person needs to get HIV testing as often as they should other STIs, so why does Nurx include an HIV screening in all of their STI test options? “For HIV, for sure the main population that is getting infected are youth, particularly boys of color, then young black women and Hispanic women, and then white women,” she says. “But sometimes statistics bother me.” In her view (and experience as a nurse specializing in STI care and treatment), just because someone is considered lower-risk doesn’t make it impossible for them to contract HIV or any other STI. And the reality is that while gay and bisexual men have traditionally been the focus for HIV screenings and prevention, women made up nearly 20 percent of new HIV diagnoses in 2017.
That’s why Rymland says her team is particularly interested in reaching woman, who often lack knowledge around their risk and can also be reluctant to approach sexual health testing for a host of cultural reasons. “There’s a lot of discomfort with providers around talking about sex with women, so this is the way to allow women to test freely without stigma,” she tells me. “We don’t see their face so they can ask whatever questions and speak comfortably about the sex practices that they like.”
Of course, Nurx isn’t the only company offering at-home STI testing. Everlywell has a male and female STD test kit, which tests for chlamydia, gonorrhea, Hepatitis C, herpes Type 2, HIV, syphilis, and trichomoniasis; LetsGetChecked sells a variety of tests for individual STIs like herpes, hepatitis B and C, and chlamydia. But Nurx seems to be the only company that accepts insurance, which makes it a much more affordable option if your provider is covered. (Consider the Full Control test’s $75 price with insurance, compared to the $200 you’d pay for Everlywell’s equivalent female STD kit or the $179 for LetsGetChecked’s version.)
Nurx also aims to help people beyond testing; the company’s physicians and nurse practitioners can also write prescriptions where possible (specifically, for chlamydia and trichomoniasis) should results come back positive. Rymland says that the company will also prescribe medications for the infected patient’s partner without requiring a second test. (Um, yes!) Gonorrhea is a bit trickier, she says, as many strains have become drug-resistant; after a positive test, Nurx will do a “warm hand-off” to a local clinic so that the diagnosed patient can receive an antibiotic shot. Syphilis diagnoses result in the same procedure. In the case of HIV, if a customer says they’ve been exposed to someone with HIV or their test comes back positive, the medical practitioners on staff will connect the patient to a local clinic they’ve sourced to start treatment right away.
While obtaining sexual health care has historically been cringe-y at best, NURX’s friendly, shame-free site, with its chic millennial branding, aims to make the whole process, from getting a BC prescription to now testing for STIs, feel non-intimidating and as normal as ordering something on Amazon. With their newest offerings, Rymland says her team hopes to appeal as a 24/7 alternative to uninviting STI clinics. “In a young population, sexual healthcare is really their primary care because they [usually] don’t need a bunch of other stuff,” she says. “We can be a resource for that.”
So, you tested positive (gulp). Believe it or not, your life isn’t over—here’s how to have fulfilling sex post-diagnosis. Plus, one writer wonders why it’s so hard to get safe sex advice from a doctor when you’re queer.