Stigma-free online testing for STDs
With declining safe sex practices, cases of sexually-transmitted infections on the rise
Online dating, casual hookups and a decline in safe sex practices due to a diminished fear of HIV/AIDS are factors contributing to rising rates of sexually transmitted illnesses such as syphilis, gonorrhea, chlamydia and an emerging condition called lymphogranuloma venereum.
Sexually transmitted infections have been rising across the province for several years, according to the B.C. Centre for Disease Control. About 20,000 B.C. residents tested positive last year for a sexually transmittable infection (STI).
Of the reportable, communicable STIs, chlamydia is the most common in B.C. But since most cases show no symptoms, it is believed that the 2017 number of chlamydia cases — 15,646 — represents only the tip of the iceberg. Yet if untreated the infection can lead to pelvic inflammatory disease, which can cause infertility, and ectopic pregnancies, and in men, a condition called epi-didymo-orchitis, which causes pain and swelling in the testicles.
Gonorrhea infections can also be asymptomatic, but unlike chlamydia, for which rates have been gradually increasing, B.C. experienced a drastic surge of gonorrhea starting in 2014, especially in 20- to 24-yearold females and 25 to 29-year-old males.
B.C. has also seen increases in syphilis since 2010, and the vast majority are in males who have sex with other males. If the infection is untreated, it can lead to serious complications like brain, eye and heart disease.
HIV and AIDS have been declining over the past decade but that’s mostly in people who use injection drugs. Over half of new HIV cases are among gay and bisexual men and another category used by BCCDC — men who have sex with men. Those who have HIV are more at risk of getting lymphogranuloma, a chronic infection of the lymphatic system caused by any of three different types of a chlamydia bacteria spread by sexual contact. If left untreated, disfiguring ulcers of male genitalia may occur, in addition to lymphatic disorders.
Blood-borne infections that can be transmitted sexually are hepatitis B and C. In 2016, there were a total of 1,163 cases of hepatitis B and 2,307 cases of hepatitis C across B.C. It is not known what proportion of the cases were sexually transmitted.
Dr. Mark Gilbert, medical director of clinical prevention services at the BCCDC, said while an increase in STIs is partly attributable to an increase in testing, public health experts believe sexual behaviours are also fuelling the increase. Condoms
are the best insurance against STIs but the most recent Canadian Community Health Survey showed only about half of sexually active 15to 49-year-olds used them the last time they had sex and even baby boomers have been shunning them.
Gilbert said many people avoid testing because of stigmas about infections and sexual orientation or practices. People are embarrassed and reluctant to see doctors once they believe they may have been exposed to an STI.
“It’s true that we are making big strides in society but certainly, stigma still exists as does discrimination from friends, family and the health care system.”
To vastly increase the number of tests done, public health experts realized they had to come up with a different approach, one using technology to get more people to access testing services. A program called
GetCheckedOnline was first imagined several years ago but wasn’t launched in earnest until a few years ago. It’s the first program of its kind in Canada and it has now expanded to Victoria, Langford, Duncan, Kamloops and Nelson.
Gilbert and a team of collaborators have recently been awarded a $2-million grant from the Canadian Institutes of Health Research to expand the service to Toronto and other communities across B.C. and Ontario. The service will eventually be offered in multiple languages.
The entire web-based process — from setting up an account to getting the lab forms, going to a lab and then getting results of tests through a secure web portal — is efficient and confidential. Some users don’t even give their real names, they use a pseudonym.
An 18-month evaluation of the program showed that :
■ 3,850 people were tested. More than 6,110 people used the online service between September 2014 and January 2018. About 5,000 are expected to get tested through the web portal in 2018.
■ One in 20 people were diagnosed with an STI or with HIV, the virus that can lead to AIDS.
■ 42 per cent of people who used the service said they had sex without a condom.
■ 28 per cent said they had four or more sexual partners in the 18-month period.
■ 15 per cent of people said they had an STI in the past year.
■ 98 per cent of the online service
users said they’d use it again.
Once web users establish a profile, their “risk assessment” will provide them with a tailored testing protocol.
Gilbert said the goal is to continue to expand the program, through partnerships with other entities such as the B.C. Cancer Agency. Cervical cancer and oral cancers can both be caused by HPV, a sexually transmitted infection. In the future, Gilbert thinks it may even be possible for women to be offered self-collection vaginal swab kits through the GetCheckedOnline portal.