STI Testing via the Internet: Pros and Cons

This post first appeared on the Good Vibrations Magazine.

I recently received a press release about STD Test Express, an online service designed to make getting tested for sexually transmitted infections easier. At first, I thought it was a great idea. After thinking about it, I still think it’s a good idea but not perfect.

Here’s how it works. You go to their site, select which tests you want and pay with a credit card. You get a printout that you take to the closest lab (they have a search function) and give them a blood and/or urine sample. It’s fast, it’s easy, and nobody will know why you’re at the lab since the same sites also do lots of other medical stuff. If you test positive for anything, you get a phone consultation with a doctor who can write prescriptions as appropriate.

First, here’s what I like about it:

It makes it a lot easier for folks to get tested if they don’t have an STI clinic nearby or if they can’t get to the clinic. Many STI clinics are open for limited hours, or fill up quickly which makes it a time-consuming process.

If you’re nervous about walking into your local STI clinic or Planned Parenthood, you don’t have to worry about that. You could be going to get your blood sugar tested, your liver function tested, your cholesterol tested, or anything else. So it may feel a lot more private.

You can select which STIs to get tested for, which can be useful if you know what you’ve been exposed to. They also have an online form that you can fill out to figure out which tests to get.

Having said all that:

It’s not cheap. Most of the tests are $79-99, although you can get all 8 for $249. This creates a barrier to access to health care and STI testing for people who can’t afford to pay for it. That $249 would go a lot further towards health care for more people if it went directly to the clinic.

While it’s a confidential service, it only offers the illusion of anonymity. Since they have your name, credit card number, email and mailing addresses, it only feels anonymous in the sense that nobody knows why you’re going to the lab. They do offer this confidentiality info:

Your lab tests and results will not appear on your permanent medical records without your explicit permission.

Your lab tests and results will not appear in any insurance records.

We will not sell or rent your personal data.

We keep credit card information safe never storing anything other than the last four digits and transferring all financial information using a Secure Socket Layer (SSL encryption).

We destroy all personal results data after 90 days.

Many systems integrations use an HL-7 interface, the industry-standard for secure personal health information data transaction. All systems integrations occur over SSL.

This is definitely a step up from going to your regular doctor, in terms of whether insurance companies can access this information. But I’m skeptical of how well this will play out in real life, if only because private information has been hacked, stolen or leaked from plenty of companies. Plus,many states have mandatory reporting for certain STIs and I can’t find any info on their site about how that works.

I’m also not thrilled with their risk assessment on the recommendation form. The form doesn’t have room for transgender or intersex respondents, it doesn’t ask enough about sexual history (such as the number and genders of your partners) to give an accurate assessment, it doesn’t ask about alcohol and drug use, and it seems to equate the risk from all sexual acts (even though there is a spectrum of risk). A well-trained testing counselor would do a much better job of interviewing a client and assessing what tests somebody needs. And speaking of counselors, there’s also no pre-test counseling so there’s a lost opportunity for safer sex and sexual health information.

And while it’s great that they have doctors available for phone consultations, they don’t seem to say anything about what training these folks have in dealing with sexuality issues. Maybe the person on the other end of the phone is comfortable talking about using meth, barebacking, having multiple partners, fisting, or other things that lots of people do that can affect their risk. But there’s nothing on the site to suggest that.

So while there are some definite advantages to this model, there are some clear drawbacks and I don’t think that it’ll suit everyone. If you have safe access to an anonymous STI clinic, I think that’s still a better option. Plus, you can make a donation and help other people have access to health care, too.

(Lastly, I just need to say that it annoys me that they talk about STDs when the more accurate term is STI. That’s because you can have an infection without having a disease, and safer sex advocates and educators have been using the latter term for years. I’d really like it if these folks did, too.)