Youth go online to screen for STDs

JOHNS HOPKINS (US) — Offering free confidential home-testing kits on the Internet appears to be the best way to get teens and young adults to undergo screening for sexually transmitted infections.

An online program, I Want the Kit, started in Baltimore in 2004 lets men and women in their teens or 20s order confidential home-testing kits for the most common STDs, Chlamydia trachomatis, Neisseria gonorrhoeae, and Trichomonas vaginalis.

The site now routinely gets 100,000 monthly hits.

“Our results are repeatedly showing us that we have to go online if we want young people to be screened for sexually transmitted infections, especially young people in harder-to-reach, urban-poor minority groups,” says infectious disease specialist Charlotte Gaydos, professor of medicine at Johns Hopkins University and senior study investigator.

Details of the study are reported in the journal Sexually Transmitted Diseases.

As of Jan. 1, some 3,500 young people, half under the age of 23, and many from low-income households, have gotten their test kit for free via the Web site, some more than once. Initially, kits were also offered at local pharmacies and in public health clinics, but nine of 10 who used the kit ordered it online.

“The Internet is by far the most popular means of getting tested among this sexually active group, and at a time when they are most at risk of becoming infected.”

Initally, the programs was only offered for women. Gaydos says it “could readily be introduced to all 50 states and overseas.” Kits for both sexes can now be ordered in Maryland, the District of Columbia, West Virginia, Denver, Philadelphia, and in parts of Illinois.

An influx of orders is expected after federally funded newspaper and radio ads promote the Web site appear in Washington, D.C., throughout Maryland and in Philadelphia during April, national sexually transmitted infections awareness month.

Each home test kit comes with instructions, a unique identification number, and a prepaid return envelope to return self-collected vaginal, penile or rectal swabs in specially sealed test tubes.

The kits are mailed in plain, brown paper envelopes and contain a detailed questionnaire that allows researchers to gather important information about who used the kit and why.

Within two weeks of sending the test to the lab, participants can call a toll-free number, provide their identification number and a secret password chosen when they ordered, and get their test results.

So far, 444 women and girls, some as young as 15, and 192 men and boys, for whom screening started in 2006, have tested positive for one or more bacterial or protozoon infections. All but four women and one man who tested positive sought treatment.  For those who test positive, referrals are offered to nearby public health clinics.

“Using the Web is a very safe, private, secure and practical forum for young people to deal with sexually transmitted infections,” says Gaydos.

“People can order a kit any time of day, without having to leave school or work, and can get tested with a level of anonymity that minimizes any fear of stigma or self-conscious feelings that may come with talking to a parent, school counselor, or health professional about a sex-related health problem.”

To make kit-ordering easier, the project has incorporated product bar coding in its brochures and advertisements.

Potential users can take a picture of the bar code with their cell phone, open an app and be taken, automatically, to the ordering page of the Web site—important for reaching underprivileged youth, says Gaydos, especially those who can’t afford a home computer and whose access to the Internet is mainly through their smart phones.

The latest study results focused on women and showed that over a five-year period in Maryland, screening program detected more cases of chlamydia infection among young females than regular screening programs available at traditional family planning clinics.

Infection rates for chlamydia, which if left untreated can lead to so-called pelvic inflammatory disease and infertility in women, ranged from 3.3 percent to 5.5 percent in local clinics to 4.4 percent to 15.2 percent with the Internet service, statistics that demonstrate the online program’s potentially greater reach.

“A lot of these young women are poor with little to no health insurance, and seldom see a physician or undergo a health check-up, so this is a free means of getting them tested and cared for quickly and before they potentially pass the infection on to someone else,” says Gaydos.

At least four in five people infected show no symptoms, so the chances of them unknowingly spreading infections are high.

The program, funded by the U.S. Centers for Disease Control and Prevention, is also effective in promoting retesting—17 percent of users feel comfortable enough with the system to use it again and almost half have been screened multiple times, even if they test negative at first.

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