What to Know About Telehealth for STIs

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Telehealth for sexually transmitted infections (STIs) can be a good option for people who are more comfortable talking about sexual health in the privacy of their homes. However, it must be used judiciously and usually requires appropriate in-person testing.

Very few sexually transmitted diseases can be correctly diagnosed on the basis of symptoms alone. That is why syndromatic treatment for STIs is generally reserved for low resource settings; for example, where the cost of testing is prohibitive or where it is difficult for people to return for test results.

Remote medical appointment on a laptop
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When to Use Telehealth for STIs

The COVID-19 pandemic increased interest in and access to telehealth services. Many people learned that telehealth could be a good option for replacing in-person care.

Where people have the resources to engage in telehealth effectively, it can reduce travel time and other costs associated with going to see a physician. However, telehealth isn't equally valuable for all conditions.

STI care is one of the situations where telehealth is sometimes a good option, but not always. Since most STIs require some form of laboratory testing to aid in the diagnosis, telehealth alone won't cut it for figuring out if you have an STI.

However, telehealth can be a great way to follow up on diagnosis and treatment. That's particularly true if used in combination with scheduled laboratory testing where people can provide a sample at a convenient time and then follow up with their healthcare professional using telehealth.

Telehealth can also be a good option for partner notification and treatment. Indeed, this is one of the few areas where there has been research into telehealth and e-interventions for STI care.

Partner notification and contact tracing can be used to reach out to, and sometimes presumptively treat, sexual partners of those newly diagnosed with an STI.

In general, telehealth for STIs may be a better option for ongoing treatment and prevention than the diagnosis of an STI after a new exposure.

Even before the COVID pandemic, researchers found that telehealth could be a great option for educating patients about preexposure prophylaxis (PrEP) for HIV and for getting a patient started on a new medication regimen.

The investigators also discovered that people accessing STI care using telehealth were very good about complying with the recommended laboratory testing.

You May Need to Be Seen in Person If...

If you are concerned about new sexual health symptoms, you probably will need to be seen in person, at least for laboratory testing.

It may be possible for the healthcare professional's visit to happen using telehealth but, depending on symptoms, you will probably need to provide either a blood sample, urine sample, or other swab test for actual diagnosis.

While STI home tests are available, the most reputable tests will still require you to visit a lab.

Benefits and Challenges of Telehealth for STIs

There are numerous potential benefits to telehealth for STIs. Many people prefer to get their STI and sexual health information online. It can be seen as less scary or intimidating than talking about risky sexual behavior with their regular primary care provider.

As such, there is a significant interest in online and other telehealth interventions for sexual health care. Telehealth may offer people an opportunity to talk with sexual health experts.

It may also make them feel more comfortable disclosing potentially stigmatized aspects of their sexual identity, such as the gender of their sexual partners or the types of sex they engage in. It may also give them the opportunity to engage with experts in the sexual health care of sexual and gender minorities who they don't have access to locally.

Challenges

Telehealth for STIs also has significant challenges. The biggest challenge is that STI testing and treatment almost always require laboratory testing and follow-up. There is no way around that.

Also, people may have significant privacy concerns around STI testing and diagnosis. This may make them reluctant to engage with telehealth, particularly if they live in an environment where privacy is difficult to find.

How to Prepare for a Telehealth Visit for STI Care

To get ready for any telehealth visit, it can help to write down your questions and concerns. That's even more true when getting telehealth for STIs. When getting ready for your visit, think about why you wanted it.

If you have new STI symptoms, be ready to talk about what they are and when they appeared. You should also be prepared to talk about when you last had sex or any sexual contact with someone who might have a sexually transmitted infection.

Try to come up with questions you have about your sexual behaviors and the risk of getting a sexually transmitted infection.

If you are trying to get started on PrEP, your healthcare professional will probably ask you what your HIV risk factors are. This helps to determine if you are PrEP eligible.

You will also be asked to have an HIV test before starting PrEP and may need other blood tests to check your kidney function and do other screenings before receiving your initial prescription.

If your sexual partner has tested positive for an STI and you are seeking follow-up care, it will be helpful if you know:

  • What STI they tested positive for
  • When they tested positive
  • When you last engaged in potentially risky behavior

That information will help your healthcare professional decide if presumptive or expedited STI treatment is appropriate or if you should be tested first.

Will Insurance Cover Telehealth for STIs?

The COVID-19 epidemic has substantially changed the landscape for insurance coverage for telehealth in the United States. Therefore, insurers are now substantially more likely to provide coverage than before. Check with your insurer about whether they will cover telehealth for STI testing and treatment.

Insurers may be willing to cover a telehealth visit for your consultation. However, even if telehealth is covered, you may still need to visit a clinic or lab for testing. At-home testing may be an option in combination with telehealth, but check with your provider.

Individuals who are not insured may be able to access free or low-cost STI testing and treatment through a Title X clinic, federally-qualified health center, or public health clinic.

What Happens During Telehealth for STIs

Before you have your telehealth visit, the healthcare professional's office will provide you with instructions for how the appointment will work.

This will include letting you know if you need to download any special software. If the appointment instructions don't say, you should feel free to ask questions about how the appointment will work before logging in.

The telehealth visit might include a physical exam; consider addressing this early in the visit with your healthcare professional, given the sensitivity of the areas affected by STIs.

In general, telehealth for STIs is like other telehealth visits:

  1. You will log into the virtual waiting room using a link provided by your healthcare professional.
  2. When the healthcare professional is ready, you will discuss the reason for your visit.
  3. Your healthcare professional will likely take a sexual history and ask about any known exposures to STIs.
  4. If the healthcare professional needs to examine you, they will talk you through how that will work.
  5. The healthcare professional may recommend STI testing, and you will likely be referred to a lab to give a blood and/or urine sample.
  6. While sometimes treatment will be prescribed without lab testing, this is unusual. It is more likely that your healthcare professional will wait for your test results and then call any needed prescription into your pharmacy for delivery or pickup.

Most telehealth for STIs is follow-up care or combined with laboratory testing. That is because it is very difficult to diagnose and treat STIs without appropriate testing.

Initial telehealth visits for STIs will almost always involve a lab test. Follow-up visits may or may not involve referrals for further lab testing depending on whether you are still experiencing symptoms.

A Word From Verywell

Telehealth for sexual health is something of growing interest to many people. It can be a great option for many sexual health concerns, including problems with sexual dysfunction in men and women.

Right now, standalone telehealth for STIs doesn't really exist. Laboratory testing is too important a component of care. However, a growing number of companies offer at-home and online STI testing options, where positive test results are addressed using telehealth.

This model may grow in the future and not just for commercial testing companies. As patients and providers both become more comfortable using the technology, telehealth visits combined with lab testing may become some people's preferred method of STI care in the future.

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Article Sources
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