Up to half of sexually active young people will get a sexuallytransmitted disease by the time they are 25, yet many don’t seektesting because it may be difficult, costly or embarrassing.
Public health officials nationally and in particularly affectedcities like Baltimore, however, say they’ve found a method thatseems to address the major hurdles — a website that supplies freein-home testing kits for three of the most commonly reportedSTDs.
“The highest prevalence is in young adults, and we knew we hadto reach these kids,” said Charlotte A. Gaydos, a professor ofinfectious diseases at Johns Hopkins University in Baltimore. “Theywere always on the Internet, and now, on their smart phones. Theyweren’t going to ask their mothers to take them to a clinic.”
Gaydos helped develop the program called “I want the Kit,” andits website, (iwantthekit.org), which now serves primarily teensand young adults in Maryland, Washington, West Virginia, parts ofIllinois, and in Denver and Philadelphia. It’s one of manynationally to try to reach this population, but public healthofficials say its ease and anonymity make it especiallyattractive.
STD experts say other effective testing and treatment effortsinvolve in-school clinics and a program called “Expedited PartnerTherapy,” which allows those who test positive for gonorrhea orchlamydia to take home antibiotics for up to three partners. Alsohelping get the word out is a campaign called GYT, which stands forGet Yourself Talking, get Yourself Tested, and taps MTV toencourage discussion and screening.
The direct impact of these programs so far on infection ratesisn’t known — the Hopkins program has only been operating since2004 and other programs are newer. and results on the threediseases for which the U.S. Centers for Disease Control andPrevention collects the most data are mixed: Gonorrhea cases are atthe lowest level on record; chlamydia cases are up, but officialsbelieve this is because of expanded testing; and syphilis cases aretrending up after hitting a low in 2000.
But I want the Kit and others hold promise in increasing testingand spreading information about STDs and their consequences, saidDr. Charlotte Kent, a branch chief in the CDC’s Division of STDPrevention. Gonorrhea and chlamydia can cause infertility andchronic pain. Syphilis can cause malformation and death in babies,as well as heart disease, blindness and neurological problems.
Many people don’t get tested because they have no symptoms, Kentsaid. (Gonorrhea can have symptoms, which has helped increasetesting and treatment.) Private doctors’ offices, where most casesare discovered, also are still not offering tests enough. and shesaid enough young people aren’t asking about testing or trying toprevent infection.
“There are things people can do to impact STDs, and thatincludes talking to their providers and getting tested and usingcondoms,” Kent said. “If everyone was getting screened andappropriately using condoms in new relationships, it could make ahuge difference.”
I want the Kit was set up to be easy, said Gaydos. People canget to the website through Facebook or with a smart phoneapplication that reads barcodes printed on program brochures, whichhave been left in schools and clinics. Kits are mailed in a plainenvelope with the swab, questionnaire, information about STDs andconsent form.
About 43 percent return the swabs.
Patients are given an identification number and passcode to gettheir results by phone in two weeks. Appointments are made in alocal clinic of the patient’s choice for those who test positive –up to 13 percent depending on the gender and STD. about 3,500 youngpeople, half younger than 23, have gotten tests from the site, somemore than once.
Almost everyone goes to their appointment, said Mathilda Barnes,who sets them up from Hopkins, and gets antibiotics.
Kent said the effort to increase testing in general should get aboost when the health care reform law begins to cover more people.Tests will be covered with no co-pays because they are consideredpreventive services. and because anonymity is so important toteens, the CDC is working to change a requirement that insurersnotify patients of the services used — an “explanation ofbenefits” that is mailed home to parents.
Programs like the one at Hopkins offer confidentiality already,said Kent. that will be especially important in places likeBaltimore, hard hit with infections. STDs in general have hit poorand minority communities the hardest because they tend to lackawareness and access to health care, Kent said.
Gonorrhea and chlamydia are included in the Hopkins test kitbecause testing requires only a swab. The kit also includes a testfor trichomoniasis, and though cases are not reported to the CDC,it’s estimated to be the most common STD infection with more than 7million new cases nationally every year.
Gaydos expects an uptick in kit users in April, nationalsexually transmitted infections awareness month, followingfederally funded newspaper and radio ads.
The site may not yet be big enough to significantly bring downthe infections, but users have praised the service in e-mails. Theysay they’ve relied on it after finding out a partner had sex withother people or they’ve had unprotected sex. Many say they don’twant their parents to know they are having sex and might beinfected.
Some say they can’t afford to go to the doctor for testing. Onethought it was an easy way for both partners to be tested beforethey had sex.
Gaydos and her colleagues would like to add syphilis or HIV tothe program, which is paid for with government grant money. Eachkit costs Hopkins about $65-$70, which includes the mailing, testand lab worker time. Those STDs, however, requires a blood testthat would make an in-home kit tougher.
She also would like to continue expanding the program beyond thecities and states it now serves.
“A lot of these young women are poor with little to no healthinsurance, and seldom see a physician or undergo a health checkup,so this is a free means of getting them tested and cared forquickly and before they potentially pass the infection on tosomeone else,” said Gaydos.
Gaydos said Maryland was a logical place to launch the programbecause of its high infection rates. CDC surveys of risky behaviorshow almost a third of students in Baltimore are sexually active bythe ninth grade.
CDC data shows that Maryland ranks in the top 20 states for STDcases. Many of the cases are in Baltimore, where there were 2,889cases of gonorrhea in 2009, 7,889 cases of chlamydia and 244 casesof syphilis in 2009, according to the Baltimore City HealthDepartment — though only chlamydia cases have been rising inrecent years.
They all remain a challenge for local officials, said SherryKetemepi, the city’s assistant commissioner for clinicalservices.
She said the city works with Hopkins and others on programs toreach those most at risk. She said schools offer health educationand encourage testing in their clinics. and city health officialssought permission from the state legislature three years ago tojoin the CDC’s Expedited Partner Therapy program.
Another program rewards youth for referring a friend for testingat a city clinic with a movie ticket or other prize.
But she said the Hopkins program eliminates a main barrier totesting because it’s anonymous.
“There’s a stigma to going to a clinic to be tested for an STD,”she said. “It’s an easier way to get people tested.”
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