Rates of sexually-transmitted infections are at record levels, but testing rates have fallen during the pandemic. Planned Parenthood of Northern New England hopes that at-home testing can help close the gap.

By Kelly Burch

Granite State News Collaborative

While coronavirus is the public health issue that’s most concerning for many New Hampshire residents, the state is quietly experiencing an outbreak of other viruses, including the sexually-transmitted infections syphilis and gonorrhea. To help combat that and overcome the fact that fewer people are coming to health clinics for STI testing during the pandemic, Planned Parenthood of Northern New England has started offering at-home STI testing. 

Stigma, cost and just the time to get to a clinic for a test are all barriers to STI testing for many people. Those have been made worse during the pandemic, said Dr. Donna Burkett, medical director of Planned Parenthood of Northern New England (PPNE), which covers Maine, New Hampshire and Vermont. Job loss has led to fewer people with insurance, and less disposable income, while having family members home all the time can make it hard to slip out to an appointment. 

“These barriers have been exacerbated as the unemployed and uninsured rate has increased and health centers are seeing fewer people in person,” said Burkett. Then, of course, there’s the risk of COVID. “A person seeking testing may be fearful of going out due to the coronavirus or may be in quarantine for a number of reasons.”

The new at-home STI testing program will address these barriers. The program allows people to book a tele-health appointment with a PPNE provider. Since New Hampshire expanded coverage for tele-health services during the pandemic with emergency order 8, issued by Gov. Chris Sununu on March 18, the cost of this appointment should be covered by insurance. PPNE offers low- and no-cost options for the uninsured. 

After a discussion with the doctor, a testing kit is mailed to the patient in discreet packaging with pre-paid postage for return. The patient collects their sample and mails it back to PPNE, which usually has test results within 48 hours. The at-home samples are processed using the same lab as in-person samples, so they’re just as accurate, according to PPNE. 

Although PPNE clinics still offer in-person STI testing, some patients find at-home testing more comfortable. 

“At-home STI testing minimizes concerns about stigma for some patients by allowing them to get tested from the privacy of their home,” Burkett said. 

Testing can be done at home for gonorrhea, chlamydia, and trichomoniasis. Testing for syphilis, HIV, and hepatitis B requires blood samples, so these are not available for at-home testing through PPNE. The FDA has approved an at-home HIV antibody test that uses saliva, but Planned Parenthood doesn’t offer the test. 

Many people with STIs have no symptoms, so testing is important — something that the public should understand now more than ever. 

“It’s important to remember that oftentimes people who have an STI are asymptomatic -- increasing testing accessibility helps to reduce asymptomatic transmission, just like with COVID,” Burkett said. 

Anyone who has had new sex partners — for vaginal, oral or anal sex — should be tested, Burkett said, rather than waiting for symptoms to appear. 

“Most of the time, STIs have no symptoms. Testing is the only way to know for sure if you have an STI,” she said. Even if symptoms do appear, they can be easy to ignore. “It’s common for STI symptoms to be so mild that they don’t bother you, but you should still see a doctor or nurse if you notice anything that feels off.”

The Centers for Disease Control and Prevention (CDC) recommends that sexually-active women under 25 be tested for gonorrhea and chlamydia annually; and that men who have sex with men be tested for syphilis, chlamydia and gonorrhea annually. It’s also recommended that all pregnant women get an STI screening, since STIs can cause pregnancy complications. 

STI outbreaks are tracked using many of the same tactics that the country is using to reduce the spread of COVID-19, including plentiful testing and contact tracing. A survey by the National Association of County and City Health Officials found that many public health departments have scaled back or stopped their efforts to address the spread of STIs because their resources are being redirected toward COVID response. 

This is concerning to many public health officials, since STI levels were at epidemic levels even before the pandemic. According to CDC data for 2018 (the most recent year available), infections of syphilis, gonorrhea and chlamydia were at their highest levels ever. Alarmingly, there was a 22% increase in infant deaths related to syphilis between 2017 and 2018, although the numbers remained low, at 94 deaths nationally. 

In New Hampshire, data shows that chlamydia rates are highest in the southern areas of the state, among people under 30 and women of all ages; gonorrhea is most common in Manchester and the rest of Hillsborough county, among people age 20-39 and men; syphilis is in outbreak status and is most common among gay men, but is not associated with a specific area in the state. HIV rates have remained stable since 2014, although between 2017 and 2018 there were more cases among IV-drug users. The state continues to get new reports of STIs, even since the pandemic. 

Given this information, it’s critical that people in New Hampshire be screened for STIs, even when concerns about COVID might be more prevalent,” Burkett said.

“Taking care of one’s sexual and reproductive health is essential care that cannot wait, even during a pandemic,” she said. 

These articles are being shared by partners in The Granite State News Collaborative. For more information visit collaborativenh.org.