By Jane Harrison-Hohner, RN, RNP
Questions from our readers bring forward some of the most interesting topics. After last month’s blog on home pregnancy testing, I received a query about home vaginal infection testing. This spurred an investigation about all facets of do-it-yourself (DIY) vaginitis care. Here, as a two-part series, is what I learned about home testing kits. Next month, we’ll cover over-the-counter vaginitis treatments.
Vaginal Infections 101
Vaginitis is a general term that covers fungal (“yeast”) and bacterial infections within the vagina. Vaginitis can be an overgrowth of organisms normally found in the vagina or surrounding genital-rectal skin (e.g. yeast or bacterial vaginosis/BV). Some types of vaginitis can only be acquired by sexual contact, also known as a sexually transmitted infection or disease (“STD”). Examples of STDs which infect the vagina are trichomoniasis (“trich”), Chlamydia, and Gonorrhea. Unfortunately, if you are a woman with a new vaginal discharge, itching, or a malodor, it is not easy to know if one has an STD or simply an overgrowth of one of the “normal” vaginal organisms.
Testing for Vaginitis at Home
The most readily available home test kit for vaginitis is the Vagisil Screening Kit®. The cost at my local chain pharmacy was $17.50 ($15.00 for store brand). While availability and cost are good, the diagnostic capacity of this home test is very limited. This kit checks for vaginal pH. It does not indicate causes of symptoms (e.g., itching, burning, bad smell or unusual discharge), nor can it identify a specific type of infection. At best, it can indicate a more alkaline pH — 5.0 or greater, which suggests that either bacterial vaginosis (BV) or trichomoniasis (“trich”) might be present. When a pH of 3.5 is found, symptoms could possibly be from a healthy vagina or a yeast infection. Furthermore, the manufacturer suggests that the test may not be accurate if the woman is on her period, has breakthrough bleeding, is postmenopausal, or has recently had intercourse. Thus, in most instances, a woman should still see a GYN or clinic to get the most correct diagnosis.
This is not to say that very accurate results cannot be obtained with DIY home testing. Self-collected tests on urine or vaginal swabs have been used in research studies for over ten years. Such tests identify DNA from the infectious organisms using several kinds of nucleic acid amplification (NAAT) screenings. All of these NAAT tests are very accurate at identifying sexually transmitted diseases (e.g., Gonorrhea, Chlamydia, trich). In fact, two studies have shown that vaginal self-collected tests have almost the same accuracy as MD-collected swabs from the cervix during a speculum exam.
Through the internet, one can order the same types of testing kits for Gonorrhea and Chlamydia used in doctor’s offices. The reagents used for reading the results are included as well. These are very specific and reliable, but have to be purchased in boxes of 25 tests for upwards of $400.00—not including shipping. These are intended for medical offices.
Some internet sites advertise single test kits. One of the pitfalls of trying to order vaginitis or STD testing kit online is that some of the online, for-profit companies that sell these kits have little or no assurance of quality control. In 2010, an STD researcher ordered six kits from different, online, for-profit labs. She returned the tests filled with chlamydia organisms from her lab. Two of the companies never replied with results, two companies replied that the “patient” did not have chlamydia, and only two returned accurate results!
Your best bet is to avoid for-profit sites and obtain test kits through research-based programs. Women living in Alaska; Maryland; West Virginia; Philadelphia; Washington, DC; and select counties in Illinois can order free, in-home testing kits for gonorrhea, chlamydia, and trich over the phone or online. If a woman lives in selected areas of California she can also get a free test kit. Both of these research-based programs will send out kits, process them in a standard lab, and the woman can receive her results through the privacy of her home computer. If she tests positive, medications are provided through an associated pharmacy.
There is clearly a future for properly conducted in-home testing of gonorrhea and chlamydia. The medical literature has almost 80 published research studies on home testing for chlamydia. There are studies that show home testing for STDs gives excellent results in either initial testing or “test of cure” (re-testing after antibiotics to be sure the infection has gone). In one study, almost 1200 women (average age of 23 years) were either sent home testing kits or were screened in family planning clinics. Those testing at home had a positive chlamydia rate of 10%, compared to 3-5% rates in the clinic. It has been demonstrated that 98% of women can properly collect, then mail, their specimens from home. Among women doing yearly followup STD testing, the majority of women opted for home testing kits (75%) rather than testing in a clinic (6.1%) or with their own personal doctor (8.2%). Note that all of these studies were conducted by medical researchers and state health departments rather than for profit internet “labs”.
The future for in-home testing may even expand beyond the usual vaginal STDs. Health researchers are examining the possibility of testing for the STD which has been linked to severely abnormal PAP smears and cervical cancer—“high risk” HPV (human papilloma virus). A recent publication compared home test kits for sampling vaginal fluids for HPV to standard PAP smears done in a clinic. In a group of 3600 women, aged 50-65, significantly more cervical dysplasia (greater than CIN 2) was eventually found among the home tested.
Finally, for those who cannot get their sexual partner to go to the doctor, in-home testing for STDs is available to men. Both links above offer the same services to men.
Reliable testing can be available through the internet; the best programs seem to be run through public health projects. If you do decide to use one of the programs available, remember that getting adequate treatment and notifying your partner(s) are still very important. Should you be seeking screening because of known STD risks (e.g., unprotected sex, multiple current partners, or past history of an STD), remember that regular screenings and less risky sex will protect your future health.