Young People Say They Prefer At-Home STI Testing

Not that long ago, all STI testing was done in a doctor’s office or clinic. You would have to make an appointment, travel to the location, and often have a physical exam. Some people struggled with finding the time, transportation, and childcare needed to get to an appointment, while others were uncomfortable with the process.

The growth of the Internet and consumer health care companies combined with improved testing technology has led to a rise in new home-based options in recent years. And the introduction of home testing for COVID during the pandemic made us all more comfortable with the idea of being our own lab technician.

Public health experts believe that home testing has the potential to expand STI screening across the country, especially in areas that don’t have very many health care providers. Still, experts wonder whether these methods will be popular, especially with young people who may have concerns about swabbing themselves or question whether the results will be as accurate.

The good news is that a new study found that an overwhelming number of young people feel comfortable with the idea of testing for sexually transmitted infections (STIs) at home.

Researchers from the University of Michigan recruited over 760 young people ages 14 to 24 using targeted social media advertising on Facebook and Instagram. To be eligible, young people needed to have access to a mobile device that could send and receive texts, and they needed to be able to read and write in English.

Participants were sent a list of six questions about STI testing and were asked to answer three of them through text. The survey was simple. It told participants to “Imagine it’s possible to test yourself at home for STIs (chlamydia, gonorrhea, trichomoniasis) for free via a urine sample or vaginal swab.” And then asked the following questions:

• If you needed testing, would you use this free home testing?
• If it costs the same, would you prefer being tested for STIs at home or in-person? Why?
• How would you like to receive your home STI test kit if you needed one (mailed, picked up at clinic/school/doctor’s office/pharmacy, some other way)? Why?
• What, if anything, would make you uncomfortable using home STI testing?
• Do you feel confident that you could correctly collect a urine sample at home if you were given instructions? Why or why not?
• If you have a vagina, do you feel confident that you could correctly collect a vaginal swab at home if you were given instructions? Why or why not?

The majority of respondents (70%) said they would prefer testing for STIs at home over going to a doctor’s office or clinic. A whopping 91% said they would use at-home testing if it were free. Respondents cited convenience, privacy, and comfort as reasons for preferring STI self-collection kits. As a 24 year-old female said in her reply text, “Yes! Sounds like a great idea and removes like 95% of the barriers to getting tested.”

Having tests mailed directly to their home was the delivery preference for most (80%) respondents, but 39% would prefer to pick their kits up from a pharmacy, 26% would like to get them from their provider’s office, and 6% said they’d pick them up at school. Some of the young people surveyed wanted an “all of the above” approach. One participant said, “I think having them available everywhere listed would be the most important since not everyone is in the same situation.”

Young people did have some concerns about testing: 34% were worried about their ability to correctly use the test, 22% were worried about the accuracy of the results, and 19% were worried about privacy during the whole process from getting it in the mail to using it to disposing of the kit supplies.

The researchers see these results are positive despite these concerns. The study’s senior author Dr. Okeoma Mmeje said, “There is an urgent need to prioritize and increase the accessibility of sexually transmitted infection testing among youth. Self-collection is an effective alternative that addresses barriers that often deter this population from seeking traditional reproductive health care services. The autonomy and confidentiality offered through this option may empower young people to take charge of their sexual health without fear of judgment or social stigma.”

There are currently fully at-home tests available for syphilis and HIV. These tests allow you to collect your sample and get your results right away. The test kits have information about what to do if you test positive, which often includes scheduling a telehealth visit.

Most test kits currently on the market—including those for gonorrhea, chlamydia, trichomoniasis, and hepatitis C—require you to take a sample of blood, urine, or genital fluids, and mail it back to a lab for analysis. While only some of these tests have been officially approved by the FDA, experts agree that they should be as accurate as tests done in a provider’s office.

There are also tests available for herpes, but experts caution that these tests often give false positive results. You can use a home-collection test to rule out herpes, but if you get a positive result, you should be retested with a provider.