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Home health testing moves into a new arena

This article first appeared in the St. Louis Beacon, Oct. 5, 2011 - Now that home health testing has gained public acceptance, why not give medical kits to men to test themselves for gonorrhea and chlamydia? Would home testing help lower the infection rates?

These questions are on the mind of Dr. Jeff Peipert, a professor of obstetrics at the Washington University School of Medicine and a nationally recognized family planning expert. His research includes behavioral interventions to prevent both sexually transmitted infections (STIs) and unplanned pregnancies. He hopes home testing among men will be another tool to control gonorrhea and chlamydia, two of the most common infectious diseases in the nation.

Peipert's current study involves about 200 men in St. Louis and St. Louis County to find out how receptive men would be to testing themselves through urine samples. He is evaluating the effectiveness of that approach compared to visiting a clinic or doctor for a test. Men in the study are between the ages of 18 and 45. In addition to the free testing, they are given free treatment for infections and a $12 gift card for participating. Men can have the kits mailed to them or pick them up at the research site. They are later interviewed by telephone about their experience with home testing. Peipert has yet to complete the research.

"There are not a lot of studies for men in terms of screening and treatment and whether they prefer to have home-based or clinic-based testing," Peipert says. Tackling chlamydia in both men and women is a challenge because people must be convinced to visit a clinic, lab or doctor to get tested. Peipert and other researchers have found that women prefer home screening rather than clinics, resulting in a greater number of screenings.

He says home screenings offer the advantage of overcoming barriers, such as transportation, that discourage people from getting to clinics. He predicts that his research into men's attitudes will show a similar preference for home testing.

"There is not a good way to get enough high-risk people in for screening and treatment for chlamydia. That's because it's a silent disease. People who don't have symptoms don't see it as a problem. They don't think they need to be screened or treated. These are young people, mostly in the 17-24 age category, the group in the highest risk for STD."

Peipert also favors campaigns to promote condom use and educate people who might be unaware that untreated chlamydia can cause chronic pain, pelvic infections and infertility.

"We have the ability to prevent these outcomes with screening, treatment and prevention," he says. "Some people say condoms would lead to more sexual activity. But young people are going to be active anyway. In addition, kids have to be careful beyond using condoms and getting tested. They have to be careful who their partners are."

Although St. Louis has high rates of chlamydia and gonorrhea, it has made progress in the fight against STIs, according to the most recent data from the Centers for Disease Control and Prevention. For a decade, the city had routinely placed near the top in gonorrhea and chlamydia infections. But the most recent data, for 2009, showed that St. Louis had lowered its rates of gonorrhea, and that the rates for chlamydia hadn't risen as fast as it had in previous years.

The lower rates are said to be due to more screening and treatment and placing services in various locations that aren't traditionally regarded as treatment sites. One example is a West End building, called SPOT, where young people enjoy arts, cultural and education programs. City Health Department officials says there is no stigma associated with the building, and that young people willingly visit it to get help for STIs.

Peipert's project is relatively small in relation to his family planning research. He is conducting a large-scale study involving about 10,000 women to determine whether removing financial barriers to contraceptives decreases the frequency of unintended pregnancies. It's an important question at a time when research shows that about 50 percent of all pregnancies in the United States are unplanned, and at least 74 percent of teen pregnancies are unintended.

The women receive free contraceptives of their choice and they are treated if they turn out to have a sexually transmitted infection.

The call for society to look at reproductive issues in new ways has been bolstered by an Institute of Medicine recommendation that health insurance plans offer women a range of free preventive services, including contraceptives.

Funding for the Beacon's health reporting is provided in part by the Missouri Foundation for Health, a philanthropic organization that aims to improve the health of the people in the communities it serves.