Covid-19 is hogging the infectious disease spotlight for 2020. But that doesn’t mean that other illnesses have disappeared. Many experts fear that in the absence of routine preventative healthcare visits, sexually transmitted infections, or STIs, have the potential to skyrocket.
That concern, however, has created a new kind of market: one for at-home STI testing collection kits.
“We noticed an explosion of STI at-home collection test kit sales starting in March,” says Christina Song, a spokesperson for Everlywell. Along with companies like Fig, LetsGetChecked, and Nurx, Everlywell sells kits for collecting blood or urine that can be shipped back to a lab to get analyzed. “To be quite candid, we didn’t get why,” says Song. In theory, people should have been staying home during the pandemic—which would mean they’d be having less sex, or fewer sexual partners.
In practice, though, that’s not likely the case. “Some people are less sexually active than usual right now, others are reporting no changes in behavior, and some are actually more active than they were before and are pursuing new partners,” Justin Lehmiller, a social psychologist at the Kinsey Institute at Indiana University, told Vox.
It all comes down to how concerned people are about contracting Covid-19. “For those with low levels of concern, we’re likely to see them going about their intimate lives as usual, with some perhaps even becoming more sexually active for a while in order to make up for lost time,” Lehmiller told Vox.
All the while, though, the pandemic decreased capacity for clinics to handle new STI cases. A report from the National Coalition of STD Directors conducted in March found that (pdf) 60% of sexual health clinics in the US had to limit their capacity for STI screenings. A similar survey conducted in June found that nearly 80% of the workforce devoted to sexual health in this group had been reallocated to emergency Covid-19 response. This includes contact tracers, who in normal times would spend their days alerting the partners of people who test positive for HIV or other STIs.
It’s not surprising that companies like Everlywell saw an uptick in demand for at-home testing. In fact, the US Centers for Disease Control and Prevention (CDC) currently recommend them for people who want to get screened for STIs, but can’t due to limited capacity, or don’t want to make the trip to the doctor’s office for fear of contracting Covid-19.
These kits all work in roughly the same way. Once you’ve collected your samples, you ship them back to the same kind of lab that would analyze tests ordered by a primary care provider or a clinic. Prices and timelines may vary by test; most kits offer screenings for chlamydia, gonorrhea, hepatitis C, herpes, HIV, syphilis, and trichomoniasis. An independent physician is included in the cost—around $200—who can advise you on what you need to do based on your results.
That’s steep, but some companies will take insurance for these claims; others don’t, but they can be reimbursed by a health savings account. And Everlywell now offers a subscription plan called Current for people who would benefit from monthly screenings for just $14.99 per month (although this kit doesn’t include herpes testing, which has a notoriously high false positive rate).
These at-home collection kits may be a much-needed defense against the spread of STIs, even after the pandemic ends. STIs have been on the rise in the US for the past few years. A report from the US Centers for Disease Control and Prevention (CDC) showed that in 2018, there were 1.7 million cases of chlamydia—the most ever recorded. Gonorrhea cases, at 580,000, hit a two-decade high.
According to the CDC, these increases are partly related to increased drug use and decreased condom use. But lack of testing—whether because of low funding for local testing agencies or the stigma of walking into a testing clinic—is also part of the problem. “Earlier in the AIDS pandemic, we set up HIV counseling and testing centers, and people would be seen embarrassed or ashamed testing in that space,” says Charlene Brown, a physician and medical advisor to Everlywell.
Although some of that stigma has gone away—especially as more people get tested through their primary care physician’s office—at-home testing eliminates it entirely. “You’re engaging with a provider that you may not know remotely,” says Brown, which could ultimately be useful for other conditions, too.
While at-home testing offers convenience to those who can’t access a clinic right now, it still won’t reach everyone. For some people, free testing is the only way to make it accessible; the few hundred dollars out of pocket is still a barrier to care.
But it’s at the very least another option for people to take care of their sexual health. “While getting tested for STIs at a doctors office or clinic is still available, there’s still going to be people who don’t want to engage the system that way,” Brown says. By creating new options that reach more people, she says, more infections can get diagnosed and treated.