In case you haven't already heard, we're in the midst of an STI crisis. Rates of chlamydia, gonorrhea, and syphilis have been on a steady incline in recent years, according to Centers for Disease Control (CDC) data collected through 2014. Young people between the ages of 15 and 24 account for the biggest portion of people with chlamydia and gonorrhea; the CDC has also noted a troubling spike in syphilis cases among gay and bisexual men and an increase in STIs among senior citizens. It's impossible to pinpoint a single reason for the overall trend, but slashed budgets for STD-testing programs and the closure of Planned Parenthood clinics across the US are likely key factors. Various studies also suggest that more sexual activity across wider groups (thanks to online dating) and inadequate public education may have something to do with it, too. STIs are often asymptomatic, so people having sex without being tested regularly are unknowingly spreading infections.
In response to this unsettling trend, there's a push to solve the problem the way every problem gets solved: through apps. The goal is to make regular testing and treatments more accessible, affordable, and discreet.
"Technology is so evolved, yet we were shocked to see that STI testing was still the same as what we grew up with: going to a physician or a clinic," Lora Ivanova, an e-commerce and digital marketing entrepreneur, told VICE. "We wanted to hack the healthcare mechanism to allow everybody to access those solutions in a much faster and easier way."
Ivanova and her business partner, Ursula Hessenflow, created MyLAB Box, a kit that allows users to test for HIV, chlamydia, gonorrhea, and the sexually transmitted parasite trichomoniasis from the privacy of their bathrooms. While there are several existing companies that offer at-home tests for HIV, MyLAB is the first to offer residents of all 50 states such a wide range of at-home testing. In addition to urine tests, it also offers oral, anal, and genital swabs, which are more expensive but can be more accurate. The HIV test involves a finger prick to draw a sample of blood. Collected samples are sent via pre-paid envelope to a lab for testing, and if the results are positive, users will get a call from an STI counselor, as well as a free telemedicine consultation with a local doctor who can prescribe treatment. The kit starts at $79 for the basic urine test for chlamydia and gonorrhea. (While the costs for such tests at a doctor's office vary widely, Healthcare Bluebook predicts that a chlamydia test alone would cost about $91 for someone without insurance.)
Planned Parenthood has also gotten into this game, launching two pilot programs, PP Care and PP Direct. Like MyLAB Box, PP Care offers at-home testing kits for chlamydia and gonorrhea. A total of $120 will get you a kit that tests for both, and if the test is positive, treatment. (For an additional $25, you can get a real-time video consultation with a clinician.) Some insurance plans may bring down the costs further. The program is available in Washington State, Minnesota, Alaska, and Idaho; Hawaii is slated for the coming months.
In California, people with the PP Direct app (which is being piloted there) and $120 can have a urine-testing kit for chlamydia or gonorrhea mailed to their homes. Results are delivered through the app, and if they're positive, Planned Parenthood follows up with information about treatment and a prescription to a local pharmacy.
These services are more vital than ever in a country where access to clinics is increasingly limited. A glaring recent example: Scott County, a small, impoverished corner of Indiana, suffered an HIV outbreak linked to heavy use of an intravenous opiate after a Planned Parenthood clinic that was the area's only HIV-testing center, was closed down.
"We have more users in populated areas, but we are also seeing people in zip codes that are miles from healthcare centers," Jill Balderson, vice president of Health Care Innovation at Planned Parenthood Federation of America, told VICE. "What's been really surprising is that people accessing it are across a wide range of ages, income, and gender."
Reid Mihalko, a sex and relationships expert who hosts workshops and lectures at colleges about safer sex, sees at-home testing kits as a way to fill the gap in regular STI testing—since, while the general recommendation is that sexually active people get tested annually, he suggests doing it at least two times a year, to make the process a habit.
"There's so much stigma and shame that prevents people from getting tested," he told VICE. "It's often hard to talk about it with a primary care physician, and for many, the act of getting to an affordable clinic can be a challenge. I'm ecstatic about anything that offers shame-free testing."
The bulk of MyLAB Box users are adults ages 25 to 35—young people who are likely used to ordering everything from meals to romantic partners from the comfort of their couches. "We've seen good traction among college-aged kids who may be hesitant to go to their health center," Ivanova said, "as well as senior citizens who may want something more discreet than going to their local brick-and-mortar option."
Beyond access issues and concerns about discretion, there's a lack of education and awareness around testing. "For the past eight years, the entire public health system has been decimated in terms of funding," Jeffrey Klausner, MD, a professor of Medicine and Public Health at the UCLA David Geffen School of Medicine, told VICE. "Major cities and counties have cut their sexual health promotion, communication, and education."
For anyone who came of age in the 1980s and 1990s, most sexual health topics were centered on the fear of AIDS. Campaigns for safer sex to prevent HIV transmission naturally extended to other STIs, even if they weren't part of the conversation. Today, treatments and preventative options such as Pre-exposure prophylaxis (PrEP) for HIV and the HPV vaccine can lead to a false sense of security.
"People are not as fearful [anymore], and they have every right not to be—HIV is a treatable condition," Klausner said. "But old conditions like herpes are still out there, and new conditions like Zika virus may be sexually transmitted. Sexual activity can have serious consequences."
Back in 1999, when Klausner was director of STD Prevention and Control Services at the San Francisco Department of Public Health, he discovered an outbreak of syphilis associated with men meeting men in an AOL chat room.
"Any technology that facilitates people meeting each other, from the advent of the telephone to the internet, will increase sexual contact," he said when asked if modern hookup apps like Tinder and Grindr have led to the recent increase in STI transmission. But he also pointed out that the same online sites and social media can be used as tools to increase awareness and education.
With UCLA, Klausner launched a National Institutes of Health–funded campaign on Grindr advertising free HIV home-testing kits, which garnered 16,000 hits, 400 requests for the kit, and 20 newly diagnosed cases of HIV in a month. "That was a great conversion rate for just a hit on a website," he said.
According to him, there is new technology on the horizon that could take at-home testing to the next level—tests that wouldn't just collect samples but would also give swift and accurate results in minutes, like a home pregnancy test.
Regardless of how people will actually use these new apps, all of the experts VICE spoke to for this story expressed the opinion that at-home testing is meant to be a supplement and not a replacement for regular in-person testing. "A pelvic examination will also look for genital warts, ulcers from herpes, primary chancres from syphilis," Charlotte Gaydos, a professor in the Division of Infectious Diseases at Johns Hopkins University School of Medicine, told VICE. "This web-based alternative is not the end-all, be-all solution, but it is another tool in our box."