Even today, the topic of sexually transmitted infections (STI) can be hard to broach – but perceptions seem to be slowly changing, and it's becoming increasingly acceptable to talk about sex and, by extension, sexual health.
On Tiktok, public figures such as Jenelle Marie Pierce, creator of The STI Project – a US-based movement that focuses on breaking the STI stigma – promote STI awareness and education, targeting Gen Zs.
And closer to home, Something Private – a podcast on everything related to women's health – launched in 2019 when Singapore kicked off its first national immunisation programme for human papillomavirus (HPV), the most common STI with types that could possibly lead to cervical cancer.
In the past couple of years, there has been a subtle shift in how we discuss sexual health. Brands like Ease Healthcare and Ferne Health have also popped up in Singapore, possibly offering easier access to sexual healthcare.
Aside from some key differences – Ease Healthcare is dedicated to the entire women's health ecosystem (from support networks to period tracking tools, for example), while Ferne Health caters to males and females, and also the LGBTQ+ community – both are platforms that deliver STI test kits directly to your doorstep, and depending the type of kit purchased, they can be either be self-administered through vaginal swabs or urine samples, or through an assisted blood sample collection with the aid of a licensed phlebotomist.
Cost wise, starting prices for STI at-home test kits are similar for both brands ($49 for Ease Healthcare, and $46 for Ferne Health). Xi Liu, founder of Ferne Health, explains: "We get asked a lot about how these testing kits work. They are not the same as rapid tests like the ones you use for Covid-19, where you get results instantly.
"When you purchase a testing kit (from Ferne), you provide us with a sample (either self-administered or aided by a licensed phlebotomist), which we send to an officially credited laboratory. All this takes time. Our tools aren't so different from those of clinics, and your samples are transported properly."
Similarly, when it comes to the safety of these tests, there are procedures in place so results are not compromised.
"In terms of blood tests, a licensed phlebotomist visits your home to pick up your samples, which means that the procedure is still done by a professional, just as it would be in the setting of a clinic," says Guadalupe Lazaro, co-founder of Ease Healthcare.
Possible risk of a false negative result
One might ask, "If STI home test kits are available, is there still a need for me to see a doctor in real life for my sexual health?" The answer: These tests are an added boost to a routine check at the clinic.
According to Xi Liu, for Ferne Health customers who regularly purchase STI home test kits, getting tested is part of a routine check-up that they do. They are testing for that "peace of mind".
At the same time, they may be saving on the transport costs and time spent when they make a physical appointment at a clinic.
Then there is another demographic of users: Those who are showing symptoms, but don't know what they're faced with just yet.
"As they are displaying symptoms, they are at a higher risk of possible complications, and they need proper medical attention. We then recommend that they see a doctor right away to seek immediate and effective treatment, because that should be the priority," she says.
On the flip side, interesting points about the limitations of these at-home test kits were raised when we spoke to various doctors.
Dr Julian Ng, deputy CEO of Republic Healthcare Holdings, the parent company of sexual health clinic Dr Tan & Partners (DTAP), agrees that such test kits are convenient and take the stress and stigma out of visiting a clinic for STI tests.
However, he questions the issue of "user error".
"Test results are dependent to an extent on the proper collection of samples for testing. It is thus imperative that proper detailed and easy-to-follow instructions are given to people using DIY kits. If instructions are not clear or detailed enough, it runs the risk of the test result being inaccurate.
"In the worst case scenario, someone with an infection may have a false negative result due to improper collection. This means that if the user fails to collect the sample correctly in the first place, and if they actually have an infection, they cannot and will not be treated properly."
Dr Ng also adds that like any infection out there, STIs have a window period after infection before a test result will turn positive, noting that if patients are not aware of these technicalities, they may be given false assurance by results from the at-home test kits.
One must also note that the Ministry of Health does not have any licensing, registration or regulatory purview of these kits.
Adding his take on the issue, Dr Tan Kai Lit, consultant obstetrician and gynaecologist at Thomson Surgical Centre, zooms in on HPV tests.
Not all at-home test kits offer the option for HPV testing, and this is where gynaecologists step in to fill the "gap" and carry out tests that can "cover more ground".
"Whether the patient chooses to do a pap smear or a specific HPV screening, these clinic tests can detect the virus and/or cervical cell changes," he says.
Dr Tan also points out how STI home test kits may not include testing for lesser-known STIs, such as trichomoniasis, a common sexually transmitted infection caused by a parasite.
However, with a visit to a specialist clinic, you can have conversations with a professional and make educated decisions together on what tests are best for you, depending on factors like the type of symptoms you may be displaying, or your general sexual health concerns.
Whether you choose to get a supervised STI at-home test kit done or schedule a routine visit with your doctor, what both experts and brands can agree on is this: As long as you're sexually active, getting tested for STIs is the responsible thing to do, as it is the first step to protecting not only yourself, but also your partner.
Early detection can help minimise the risk of transmission to others, and if symptoms are present, it can also help prevent effects from worsening.
The importance of HPV awareness
A 2021 report released by the HPV Information Centre indicates that each year, 309 women in Singapore are diagnosed with cervical cancer, and 172 die from the disease.
Nearly all cervical cancers are caused by a human papillomavirus (HPV) infection of high-risk types, such as HPV 16 and 18.
And if HPV is one of the most common STIs out there, why is it not always part of an STI panel? Dr Tan agrees that this is an interesting observation, and has his theories as to why this might be the case.
Firstly, unlike many other STIs, HPV doesn't usually cause any symptoms. This makes it hard for patients to even request a screening, especially if they aren't aware about what HPV is in the first place.
Dr Tan also feels that it has a lot to do with how the virus functions.
"For a high percentage of women with HPV, the condition can clear on its own within a few years. But women need to understand that there are a few strains like type 16 and type 18 that present high risks of cervical cancer."
He urges women who are sexually active to go for a HPV screening, and encourages all to talk to their healthcare providers about getting vaccinated, and how the different HPV types relate to the vaccination options.
Know what you're dealing with
When you go for a check up, what exactly are you getting tested for? Here are what most comprehensive screenings cover:
Chlamydia, Gonorrhoea & Syphilis
These diseases are caused by bacteria, and are generally treatable with antibiotics. For chlamydia and gonorrhoea, symptoms can include genital discharge and a burning sensation when urinating. For syphilis, symptoms include ulcers, rash, and warts. All three infections, if left untreated, can cause long-term harm to reproductive systems.
The Herpes Simplex Virus (HSV-1 & HSV-2)https://www.instagram.com/reel/CbvK1TLpPMF/?utm_source=ig_web_copy_link
Affecting genital and oral areas, this viral infection falls under two categories: HSV-1 primarily causes cold sores that appear around your mouth or on your face, and HSV-2 involves sores that appear on/around one's nether regions. There is no cure for HSV, but it's a manageable condition with medication.
A virus that causes liver infection. Many who are infected don't show symptoms such as yellowing of skin and in the whites of eyes. There is currently no complete cure for it, but most people with acute hepatitis B make a full recovery. A vaccine also exists.
HIV (Human Immunodeficiency Virus)
A virus that attacks the body's immune system. Early stage symptoms include fever and a sore throat. There is currently no effective cure for HIV. It's important to note that if you take HIV medicine and maintain an undetectable viral load, you may effectively have no risk of transmitting HIV to a HIV-negative partner through sex.
A viral infection of the reproductive tract. There are about 100 types of HPV that exist, and in most cases (nine out of 10), HPV goes away on its own without health problems. However, when HPV is not treated, it can cause health problems like genital warts and cervical cancer. Vaccination and testing is key.