Summary: How Telehealth Impacts The Treatment of Sexually Transmitted Infections
- The Rising Rates of Sexually Transmitted Infections (STIs): The UK and specific demographic groups in the US have seen a doubling or even tripling of the rates of some STIs.
- Barriers to Traditional STI Treatment: Barriers such as social stigma, lack of transportation, and lack of access to healthcare contribute to the rising rates.
- Advantages of Telemedicine for STI Treatment: Advantages include decreased social stigma, on-demand access to care, and no travel requirements.
- Telemedicine Limitations: Lack of internet access in rural areas significantly affects access to telehealth services.
- The Future of STI Virtual Care: Integration of existing telehealth platforms with public health systems and widespread adoption of AI will help streamline future virtual STI management.
Introduction
The prevalence of sexually transmitted infections (STIs) in the UK has surged in recent years. Gonorrhea, one of the most common STIs, reached around 85,000 cases in 2023, which is the highest number of cases on record. The number of cases has tripled since 2012. The demand for sexual health services has reached a breaking point, while funding for such services in the UK has been reduced. In the US, rates of common STIs — gonorrhea, chlamydia, and syphilis — have doubled recently among those age 55 and older.
Professor Justyna Kowalska from the Medical University of Warsaw, Hospital for Infectious Diseases in Warsaw, Poland, spoke about the increase in STIs at a recent European Congress of Clinical Microbiology and Infectious Diseases.
“Rising divorce rates, forgoing condoms as there is no risk of pregnancy, the availability of drugs for sexual dysfunction, the large number of older adults living together in retirement communities, and the increased use of dating apps are likely to have contributed to the growing incidence of STIs in the over 50s”, she explains. “These data likely underestimate the true extent of the problem as limited access to sexual health services for the over 50s, and trying to avoid the stigma and embarrassment both on the part of older people and healthcare professionals, is leading to this age group not seeking help for STIs.”
Telemedicine is a perfect choice for those who need sexual health services, but are uncomfortable seeking in-person care or don’t have local access to healthcare.
Telemedicine became instrumental for the treatment of sexually transmitted infections during the COVID-19 pandemic. When quarantines and closures of in-person health service centers compromised the availability of healthcare, virtual visits came to the forefront. Telemedicine has since revolutionized the way STIs are diagnosed and treated.
As a family physician who practices medicine via telehealth, I’ve treated many patients for STIs via virtual care over the past several years. Patients often tell me how appreciative they are of the service, both because of the ease of access and the privacy and comfort they feel when being treated from home. In-office visits for STIs can be stressful and uncomfortable for patients; virtual visits and self-testing ease much of that stress.
My personal story of patient satisfaction with online STI care is not just anecdotal. Research recently published in PLOS Global Public Health confirms my experience. Patients and healthcare providers alike see virtual STI care as a modality that helps reduce the stigma and stress associated with sensitive health concerns. The benefits of telehealth go beyond patient comfort. Studies show that telehealth services to treat STIs can also improve outcomes compared to traditional care.
What are Sexually Transmitted Infections (STIs)?
Over 2.4 million cases of three common STIs (gonorrhea, chlamydia, and syphilis) were reported in the US in 2023. According to the Centers for Disease Control (CDC), significant disparities exist across age and ethnic groups. Almost half of the reported cases occurred in those between the ages of 15 and 24, and over 32% were reported in non-Hispanic Black people. Additionally, men who have sex with men (MSM) have disproportionately higher rates of gonorrhea and syphilis, and they are more likely to be co-infected with HIV.
The disparities in STI prevalence are linked to the lack of quality healthcare in underserved communities, as well as the stigma surrounding treatment in certain demographic groups.
STIs are infections that are transmitted to other people through sexual contact. Common STIs in the UK and the US are gonorrhea, chlamydia, human papillomavirus (HPV), genital herpes, and syphilis, all of which can be diagnosed and treated through telehealth.
Gonorrhea and Chlamydia
- Symptoms: Women can have unusual vaginal discharge, burning with urination, or pelvic pain, while men can experience penile discharge or testicular pain. Many people have no symptoms at all.
- Diagnosis: Both are commonly diagnosed by urine tests or swabs.
- Treatment: Both infections can be treated with antibiotics.
- Complications: If left untreated, both infections can lead to infertility, chronic inflammation, and pain.
Syphilis
- Symptoms: A painless sore (called a chancre) develops at the site of infection and takes several weeks to heal. If untreated, the infection persists, even after the chancre heals.
- Diagnosis: Syphilis is diagnosed via a blood test that checks for antibodies. If positive, a confirmatory blood test is needed.
- Treatment: Syphilis can be easily treated with a single dose of an antibiotic if caught early. Once the infection progresses, a longer course of antibiotics is required.
- Complications: Untreated syphilis can progress to tertiary syphilis, which causes damage to the heart, brain, blood vessels, and nervous system. Pregnant women with syphilis can infect their baby with syphilis, which can cause congenital disabilities or death.
Genital herpes
- Symptoms: The herpes virus causes painful blisters in the genital area or around the mouth that last up to a week. The initial outbreak is the most severe, usually causing fever and flu-like symptoms.
- Diagnosis: The infection can be diagnosed by healthcare providers, usually through visual inspection. There are also swabs and blood tests that can help in the diagnosis.
- Treatment: There is no cure for herpes, but antiviral medications can help the symptoms go away more quickly. A daily antiviral pill can help suppress the virus, prevent outbreaks, and prevent the spread to partners.
- Complications: Herpes can spread to the brain, leading to meningitis (inflammation of the fluid and tissue surrounding the brain) or encephalitis (inflammation of the brain). Both are rare but very serious and potentially life-threatening.
Human Papillomavirus (HPV)
- Symptoms: Most HPV infections don’t cause symptoms, although some strains of the virus will cause genital warts.
- Diagnosis: Routine HPV testing is preformed via a vaginal swab, usually done in conjunction with a screening pap test.
- Treatment: There is no cure for HPV, but for most people, the infection clears naturally. Those who develop genital warts, precancerous cells, or cancer can undergo procedures to remove the lesions.
- Complications: Certain strains of HPV can cause cancer, including cervical, anal, and throat cancers.
HIV
- Symptoms: Most people have flu-like symptoms and fever within a month of exposure to the virus, followed by several asymptomatic years. Eventually, the virus rapidly multiplies and causes the immune system to fail, causing AIDs.
- Diagnosis: A blood test can detect HIV.
- Treatment: There is no cure for HIV. Antiretroviral therapy (ART) should be started as soon as possible after diagnosis.
- Complications: AIDs, early death
How to Prevent STIs
STIs can be prevented by practicing safe sex, which means consistently using condoms and limiting the number of partners. It’s important to routinely screen for STIs as recommended by the CDC: STI Screening Recommendations. Getting vaccinated for Hepatitis B, HPV, and gonorrhea (available in the UK) also helps prevent infection.
Other ways to avoid contracting STIs include: avoiding sexual contact while being treated for an STI, taking a daily preventive pill if at high risk for HIV, and taking medication either before possible exposure (called PrEP therapy) or after exposure (PEP therapy).
What Are the Barriers to Traditional STI Care?
Stigma and embarrassment
Many people are embarrassed about potentially having an STI and avoid seeking care. They fear the associated social stigma if they visit their local STI clinic. Some can be uncomfortable even talking to their family doctor about their symptoms. In the past, a diagnosis required an uncomfortable physical exam and swabbing, which can be embarrassing and painful in the face of an active infection.
Lack of nearby clinics or specialists
Rural areas or underserved urban areas may lack access to clinics that test and treat for STIs. People living in those areas may not have transportation to these clinics, or they may have to travel long distances for treatment.
Time constraints and privacy concerns
Patients can find it difficult to miss work or to find childcare to see a healthcare provider for testing. They may also worry about the privacy of their test results, especially in small communities.
How Does Telemedicine Work for STI Treatment?
Talk: The initial consultation
In the initial consultation, patients complete an intake form of pertinent health information (such as current medications and known allergies) and then connect with a healthcare provider. The provider gathers further information about sexual health, including the number of sexual partners, any history of STIs, any known exposure to an STI, and the last menstrual period. The healthcare provider will then discuss testing options. If the provider feels the symptoms are likely an STI, they may prescribe antibiotics, even before the test results are back.
Test: At-home test kits
Several commercial at-home test kits are available through telehealth platforms that test for common STIs. Patients collect a urine sample or a genital swab in the privacy of their home, following instructions that are included with the test kit. The patient then mails the kit in a pre-labelled package to the lab for testing. The cost of these tests varies depending on the number of STIs tested, insurance coverage, and which telemedicine platform is used.
At-home STI test kits are as accurate as those done by a healthcare provider when done correctly. Sometimes, patients are referred to a local lab or clinic for in-person testing, depending on the severity of symptoms.
Treat: Diagnosis, prescriptions, and follow-up
Once the healthcare provider reviews the results, the provider will reach out to the patient via a secure platform to schedule an appointment to discuss the results, recommend a treatment plan, and educate about medication use.
Several STIs, such as gonorrhea and syphilis, are reportable by law to the patient’s local health department. Whether the patient has in-person care or virtual care, the healthcare provider is legally obligated to report the infection for contact tracing.
Education about STI prevention is also a vital part of the follow-up visit. Repeat testing, if indicated, can also be scheduled. The healthcare provider will send a prescription for the appropriate treatment to the patient’s local pharmacy for convenient pickup.
What Are the Advantages of Telemedicine for STI Care?
Increased accessibility
Virtual care is accessible from anywhere, anytime, with an internet connection. Patients don’t need to travel to get healthcare; they can consult with a healthcare provider through one of many telemedicine platforms. Lack of transportation is no longer an issue, and patients miss less work when choosing telemedicine because of the scheduling flexibility.
Reduced stigma and improved privacy
Studies show patients are more comfortable accessing STI treatment via telehealth. They can discuss a sensitive health concern, then self-test, from the privacy of their home.
Faster diagnosis and treatment
Virtual care is often expedited, given improved access and convenience. In-person appointments can take days to weeks to schedule, and some rural health departments usually only offer testing one day a week. A streamlined process can reduce the time needed to realize and treat symptoms.
Cost-effectiveness
Telehealth is usually more cost-effective than in-person visits. There are fewer transportation costs, fewer lost wages, and lower visit costs. It’s important to research which telemedicine platforms accept insurance coverage or which have the lowest prices for those without insurance. There is a wide range of costs for at-home testing and the visit.
What Are the Challenges of Telehealth STI Treatment?
The digital divide
The lack of reliable internet access continues to be one of the most significant limitations of telemedicine use. According to a study published by Broadband Now Research, an estimated 42 million Americans don’t have broadband access.
Concerns about test accuracy and self-collection
Some patients have concerns about the accuracy of self-testing, while others aren’t comfortable with the idea of self-testing. Studies have confirmed that self-testing is as reliable as testing done by an in-person healthcare provider, and have also shown that many patients who have self-tested for STIs have a positive view of the experience and would prefer self-testing to in-person testing in the future.
Limitations in treating certain cases
For those with complicated infections, in-person care may be a better choice. Serious infections can require a physical exam, IV medications, or testing that is unavailable at home. Consulting with a telemedicine provider can help patients get to the appropriate treatment facility.
Data privacy and confidentiality concerns
Some patients are concerned about the security and confidentiality of their health data. Telemedicine platforms offer secure, HIPAA-compliant sites that help patients feel more confident with their care.
Which Telemedicine Platforms Offer STI Treatment?
Many telemedicine platforms provide STI testing and treatment. Each platform offers different services at different prices. Some accept private insurance, while others don’t. The chart below looks at the specifics of STI treatment for 10 popular platforms.
Comparison of STI Services Across Popular Telehealth Platforms
| Platform | Virtual Visit | At-home Test Kits | Lab Orders | Provides Rx | Accepts Insurance |
|---|---|---|---|---|---|
| Plush Care | + | + | + | yes | |
| Lemonaid Health | + | + | + | no | |
| Wisp | + | + | + | no | |
| Everlywell | + | + | + | no | |
| LifeMD | + | + | + | no | |
| Nurx | + | + | + | yes (varies) | |
| Teladoc | + | + | + | yes | |
| MD Live | + | + | Refill only | no | |
| Doctor on Demand | + | + | + | yes | |
| GoodRx Care | + | + | + | yes (varies) |
What Does the Future of Sexual Virtual Health Look Like?
As telehealth evolves, sexual health services will become more streamlined. Improved STI reporting processes and integration of telemedicine platforms with public health systems will make contact tracing easier and help prevent outbreaks. Regulatory changes will allow more physicians to practice via telemedicine, further improving access to care.
Artificial intelligence (AI) can significantly enhance virtual healthcare for various conditions, including STI treatment. AI-powered chatbots can gather information before seeing a virtual healthcare provider. AI image recognition features can help diagnose rashes or lesions, and AI clinical decision support can help clinicians formulate the most effective treatment plan for the patient.
Today, telemedicine plays a vital role in STI care. In a time when the rates of STIs in some areas are doubling or tripling, virtual sexual health services can help stop the spread of infection by providing cost-effective, on-demand treatment without the social stigma often felt with traditional care.
Frequently Asked Questions
Can I get tested for STIs using telemedicine?
Yes, you can get tested for STIs through virtual care. An at-home test kit that checks for common STIs can be mailed discreetly to your home, with results available within a few days to a week.
How accurate are at-home STI tests ordered from a telemedicine platform?
Self-testing for STIs using an at-home test kit is just as accurate and reliable as testing done by a healthcare provider.
Can telemedicine be used to treat STIs?
Many telemedicine platforms offer testing and treatment for STIs. If your test results are positive for an STI, a prescription can be sent to your local pharmacy for you to pick up.
Is my privacy protected when using telemedicine for STI concerns?
Yes, telemedicine platforms are HIPAA-compliant, safe, and secure.
What STIs can be diagnosed through a telehealth appointment?
Common STIs that can be diagnosed through virtual care include gonorrhea, chlamydia, trichomoniasis, syphilis, human immunodeficiency virus(HIV), human papillomavirus (HPV), and hepatitis B/C.
How do I receive and interpret my STI test results when using telemedicine?
Test results can be sent through a secure messaging platform. Generally, a follow-up appointment with your virtual healthcare provider is scheduled to review the results, develop a treatment plan, and discuss ways to prevent future STIs.
Can I speak to a specialist (like a sexual health expert) via telemedicine?
Yes, sexual health experts are becoming more available virtually.
Sources & Further Reading
- Lancet Infectious Diseases: Use of a meningococcal group B vaccine (4CMenB) in populations at high risk of gonorrhoea in the UK.
- Scientific Reports: Accuracy of self-collected versus healthcare worker collected specimens for diagnosing sexually transmitted infections in females: an updated systematic review and meta-analysis.
- PLOS Global Public Health: Telehealth use for sexual and reproductive health promotion and care during the early phase of COVID-19 pandemic.
- Sexually Transmitted Diseases: A Description of Telehealth use among STI providers in the United States, 2021.
- Centers for Disease Control: Healthcare Providers/ Talk.Test. Treat.
- Sexually Transmitted Diseases: Telehealth Services: Implications for Enhancing Sexually Transmitted Infection Prevention.
- Centers for Disease Control: STI Screening Recommendations.
