Online services offer STD tests, access to results

After complaining for years that the Internet was increasing the spread of sexually transmitted diseases and associated risky behavior, public health officials are now attempting to use the medium to reverse STD incidence rates. And these efforts involve more than just delivering traditional safe-sex messages. In some areas, patients can go online and order selected lab tests, get results and even use specially designed electronic cards to notify partners.

"If people can find friends on the Internet, we should be able to find disease," said Richard Rothenberg, MD, MPH, secretary-treasurer of the American Sexually Transmitted Diseases Assn.

For example, last August researchers at Johns Hopkins University School of Medicine in Baltimore launched a Web site allowing women in Maryland to order kits for at-home specimen collection. These could then be mailed in and tested for gonorrhea and chlamydial infections. Results are available by telephone and those with positive test results are referred to local public health clinics.

In San Francisco, the Dept. of Health allows patients to order syphilis tests and access results online -- all without the hassle of long waits at a clinic. As an add-on to the usual contact tracing by public health officials, the department also hosts a Web site where patients can use e-cards to notify partners that they may have been exposed to an STD.

Public health officials are taking these actions because of growing recognition that STD rates continue to go up.

"People find contacts on the Internet," said Emily Erbelding, MD, MPH, an infectious disease specialist and associate professor of medicine at John Hopkins. "This means that we have to do the same."

And there is starting to be some evidence the idea may be paying off.

A study published in the February Sexually Transmitted Diseases, for instance, found that the San Francisco Web site where patients could order syphilis tests directly led to the detection of six cases that public health officials don't believe would have been found by more traditional methods. An additional 14 cases have been detected since that study was submitted for publication. All cases were successfully traced and treated.

"More people got tested because we provided a convenient and accessible alternative to showing up at the clinic where there could be a two-hour wait," said Deborah Levine, lead author and executive director of Internet Sexuality Information Services Inc., a San Francisco nonprofit organization. "People could go online. Take the print-out to a lab and see a phlebotomist. There was never a wait. They put out their arm and got blood drawn."

Experts widely praised the paper for documenting the impact of an innovative program that attempted to interrupt an emerging syphilis epidemic with relatively little expense. The Web site cost $20,000 to set up and costs $40 a month to maintain.

"I think it's an excellent idea at a relatively low cost," said Christine Hudak, MD, assistant director of the Riverside Family Medicine Residency in Columbus, Ohio. "We need a way for people to get tested with fewer barriers. Lots of people at risk don't have health insurance. If we're going to control syphilis, we can't just wait until people come in."

The study, though, also triggered some concern. Some experts questioned if the confidentiality of the Web site could be maintained and whether it could be duplicated elsewhere, although many suspect it may be effective in other high-prevalence areas. And while this strategy may work for tracking down syphilis cases, experts said it would be more ideal for people to come in for a full work-up.

"I think in San Francisco it's worth it, and it's a great educational resource," said Michael F. Rein, MD, a professor of medicine at the University of Virginia School of Medicine in Charlottesville who also runs a local STD clinic. "But if we can get people to come in, we can find other stuff."