Do
It Yourself Vaginitis Care: Testing
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 into 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 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, and process them in a standard lab, and
the woman can receive her results in the privacy of her home computer. If
she tests positive, medications are provided through an associated pharmacy.
There is 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. Some studies 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 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 follow-up STD testing, the majority of women opted for home
testing kits (75%) rather than testing in a clinic (6.1%) or with their 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 papillomavirus). 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 history of an
STD), remember that regular screenings and less risky sex will protect your
future health
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