Weighing the Benefits and Risks of At-Home STI Test Kits

Weighing the Benefits and Risks of At-Home STI Test Kits

Research has shown that social stigma creates a major barrier to testing for sexually transmitted infections (STIs), resulting in the underutilization of prevention services. In recent years, at-home test kits for STIs—which allow an individual to collect a sample at home instead of at a clinic—have become more common, making testing more accessible and appealing to individuals who may avoid going to a clinic due to stigma or shame. 

The ability to test for STIs from home has also been helpful during the COVID-19 pandemic. For example, individuals who receive PrEP, a medication that helps prevent HIV, require regular testing. Providing home tests at the start of the pandemic helped minimize COVID-19 exposure risk for both patients and nursing staff without disrupting access to care. 

However, there are some potential drawbacks to testing at home instead of visiting a clinic to be tested by a nurse or other healthcare professional. Potential concerns include patient error while collecting a sample, less access to sexual health counseling and lack of regulation of at-home kits produced by private companies. 

Individuals can weigh the benefits and drawbacks of home testing to make an informed decision about how to monitor their sexual health and assess when it may be beneficial to seek in-person care. 

How Common Are Sexually Transmitted Infections?

According to a 2021 study from the Centers for Disease Control and Prevention (CDC), one in five Americans had an STI on any given day in 2018, with an estimated total of close to 68 million infections. Nearly half of all newly contracted STIs were acquired by people aged 15 to 24 years old.

STIs are often asymptomatic, especially in women. Without regular testing, asymptomatic occurrences of STIs may go undiagnosed and untreated, which can lead to poor health outcomes.

Potential effects of untreated STIs include the following:

  • Chronic pelvic pain in women.
  • Infertility in women.
  • Miscarriage.
  • Increased risk of genital and oral cancers in all genders.
  • Neurological and rheumatological effects in all genders.

There are many reasons people may not get tested for STIs, said Susan Milstein, PhD, MCHES, a sexual health education specialist. Barriers to STI prevention, testing and treatment include access to care, issues of health equity, limited sexual health education and social stigma around STIs. 

At-Home Test Kits for STIs 

The distribution and use of at-home kits for STI testing has been one strategy in overcoming the stigma surrounding sexual health, said Charlotte A. Gaydos, MS, MPH, DrPH. Gaydos works with I Want The Kit (IWTK), a Johns Hopkins University program that provides access to at-home STI test kits to encourage young people to practice better sexual health.

“The privacy and the stigma which surrounds STIs is just significant,” Gaydos said. Allowing individuals to collect samples at home for testing provides a more discreet method to check for certain STIs.

How Does a Home STI Test Work?

STIs that can be tested for with an at-home test include:

Chlamydia and gonorrhea:
bacterial infections spread by sexual contact that can be cured with antibiotics.

Human Immunodeficiency Virus (HIV):
a virus that can be transmitted through sexual fluid, blood, and breast milk. HIV can be treated to maintain an individual’s health.

Methods for facilitating at-home STI testing can include:

Self collection, in which the user collects a sample following directions from the kit and mails the sample to be processed in a clinical lab. This method is used for testing gonorrhea and chlamydia.

Rapid testing, in which a user collects a sample and then uses a kit to process the results at home. This method can be used to test HIV using an oral swab. However, this type of test is only reliable if a person has detectable HIV antibodies, which usually develop three months after infection. 

While access to at-home STI testing may encourage more people to get tested, the stigma around STIs is still difficult to overcome; relying solely on at-home tests may reinforce the shame surrounding STIs, Milstein said. “How do we fight the stigma, but also accept that the stigma is real, and maybe the right thing is getting tested?” 

Home testing can also take away from healthcare professionals’ ability to connect with patients on preventative care. Testing for STIs isn’t just about finding out if someone is positive or negative, Milstein said. Working with patients in person provides clinicians and sexual health educators an avenue to share information with patients so they can remain STI-free.

“How do we fight the stigma, but also accept that the stigma is real, and maybe the right thing is getting tested?”

– Susan Milstein, PhD, MCHES

The cost of at-home STI testing is another potential challenge, according to Gaydos. While organizations like IWTK offer free test kits to residents of select states, private companies have also started to develop similar products for profit. Insurance coverage for at-home kits varies by provider, and some test suppliers do not take insurance at all. California passed legislation in 2021—the first of its kind—to require insurance coverage of at-home tests for STIs. However, the state has experienced hiccups in rolling out the infrastructure to support the new law. 

Gaydos also said that while IWTK conducts research and uses test kits that are FDA-cleared for home sample collection, there is a lack of accountability for at-home STI test suppliers in the private sector. 

“The FDA does not regulate these companies, so nobody really knows the quality of these tests or even what type of test they are using,” Gaydos said. 

Potential Benefits and Drawbacks of Using At-Home Test Methods

At-home STI test kits can contribute to improving sexual health, but there are some limitations to their effectiveness. 

At-home test kits may: 

  • Offer a more discreet method for STI testing, making stigma less of a barrier. 
  • Provide access to testing for individuals in rural or underserved areas without a nearby health clinic that provides STI testing. 
  • Allow individuals to collect samples on their own time to avoid missing work or school.
  • Free up resources for other services in healthcare facilities.

At-home test kits may not:

  • Be as accurate due to potential user error during sample collection, which could result in false positives or negatives. 
  • Be reliable due to lack of regulation of private companies and start-ups developing at-home STI testing kits.
  • Provide individuals the same level of education they might receive from consulting with a healthcare provider. 
  • Help contact tracing efforts for past partners of the person who tests positive.
  • Be covered by health insurance. As of March 2022, California was the only state that required insurance companies to cover home STI kits.

When Should Someone Seek In-Person Testing?

At-home STI testing kits can be a valuable tool in improving sexual health. However, there may be circumstances in which an individual should consider visiting an in-person clinic to be tested. The scenarios below may indicate that an individual should seek in-person care.

You have not conducted an at-home test but are experiencing symptoms.
Milstein said getting tested in a clinic can result in quicker access to medication and/or treatment, which is helpful when a person is experiencing pain or discomfort.

You tested negative at home but are experiencing symptoms.
Symptoms such as pelvic pain can also be signs of other health conditions. A healthcare provider can confirm your negative result and find the cause of symptoms.

You think you have recently been exposed to HIV.
At-home rapid tests for HIV only detect antibodies in your system three months after HIV infection. For instances of more recent exposure, a blood test is needed.

You do not feel safe at home.
Some individuals may not have the space at home to discreetly collect a sample without alerting a partner or other family members, Milstein said. In these cases, they may feel safer visiting their healthcare provider or a clinic.

Sexual Health Education Resources

There are a variety of resources available to individuals who would like to learn more about sexual health and how to get tested for STIs. The following links can help individuals navigate this important topic. 

General Information on STIs

How You Can Prevent Sexually Transmitted Diseases
The CDC provides information on a variety of topics, including STI prevention, guidance on when to get tested and what to do after receiving a diagnosis. 

STDs | Planned Parenthood
This resource page from Planned Parenthood provides information on types of STIs, how to prevent infection and general information on sexual health.

Resources for At-Home Test Kits

I Want The Kit (IWTK) 
IWTK’s mission is “to decrease the transmission and burden of STIs through free, convenient, confidential, and accurate testing and to educate our users about STI prevention.” They currently provide STI test kits to residents of Maryland and Alaska.

Springboard HealthLab, NASTAD and Emory University partnered to create this resource, which enables state and local health departments to provide free at-home STI test kits to community members. Individuals can search their ZIP code to find out if there is an eligible program near them.

Test Yourself Colorado
This program provides self-testing options for gonorrhea, chlamydia and HIV to Colorado residents ages 18 and older. Tests can be acquired for free once a year and for a low cost every three months.

Resources for Finding a Testing Location

Get Tested | National HIV, STD and Hepatitis Testing 
The CDC offers a database of free STI testing sites by location. Users can enter their ZIP code to find the closest clinic available to them. 

In addition to providing healthcare services to HIV and AIDS patients, AIDS Healthcare Foundation’s Wellness Centers located across several states in the United States provide free STI testing. Individuals can search to find a location near them.

Please note that this article is for informational purposes only. Individuals should consult their healthcare provider before following any of the information provided.