• An online sexual health site offers home-based test kits for STIs, cervical cancer and more
• Samples collected are processed in certified laboratories, with option for a teleconsultation
• Some doctors said that there are potential downsides and risks for such home screening kits
• Accuracy depends on several factors, including timing and sensitivity of the tests

SINGAPORE — These days, options are open to have a teleconsultation with a doctor or have medications delivered without patients having to leave home.

Never has virtual healthcare been more relevant during this time of physical distancing due to a pandemic, especially when limited clinic appointments make it harder for people to see a doctor or get the treatments they need.

Now, a company is offering another such convenience: Those at risk of acquiring sexual diseases can get screened for sexually transmitted infections (STIs) such as the human immunodeficiency virus (HIV) and syphilis without having to step into a clinic.

Singapore-headquartered Ferne Health claims to be the first online sexual health platform here to supply home-based screening kits for common STIs, cervical cancer as well as yeast infection.

For people who want to test for STIs, the Department of Sexually Transmitted Infections Control (DSC) Clinic is typically the place to go. It is a public specialist facility located at Kelantan Lane in Jalan Besar that provides diagnosis, treatment and control of STIs. 

Adjunct Associate Professor Martin Chio, head of the DSC Clinic, told TODAY that it is also planning to pilot home-testing kits in the future to add to its services. 

DTAP Clinic, a private clinic that offers testing for HIV and STIs, also told TODAY that in the past couple of months, it has been offering people the choice of using home kits to facilitate testing.

Its “DTAP to Home” service allows patients to receive their test kit at home after a teleconsultation with its medical team. Samples are collected and dropped off at the clinic via courier.

Alternatively, patients may visit the DTAP Express Clinic in Tanjong Pagar, get themselves registered, answer a short questionnaire and obtain a self-testing kit.

After drawing the saliva, urine or needed sample at the clinic or at home, they drop it off in the clinic’s collection bin.

Patients will get their test results via a confidential phone text message or email, and if needed, they may also pick up treatment packs for themselves or their partners thereafter. 

A medical team is on hand for teleconsultation, DTAP Clinic said, and key results are made known to the patient in less than three days compared to a week for on-site testing. This enables patients to get treatments faster, thereby reducing disease transmission to partners.

"Patients who have been initially sceptical about home testing get guided support by our medical team, especially those who have seen us in clinic before and decide to get their routine testing done at home," it added.

As for Ferne Health, the sampling kits can be bought online on its website, which was launched in September.

Once delivered, users draw the sample at home before arranging for Ferne Health to pick up and send the samples to a third-party laboratory for testing. The screening results are reviewed by its partner clinic and delivered via email.

The online platform also runs a blog that provides updates on sexual healthcare information and resources.

Ms Xi Liu, 28, founder and chief executive officer of Ferne Health, said that there has been a strong interest in the screening kits, and more than half of the buyers go for a kit that tests for HIV, syphilis and herpes — called the Peace of Mind package.

The company offers three screening kits targeted at women:

• The cervical cancer human papillomavirus (HPV) screening kit

• The gonorrhoea and chlamydia kit

• The Made for Women screening kit that tests for urinary tract infection, yeast infection and bacterial vaginosis

There is also a test kit targeted at men that screens for gonorrhoea and chlamydia.

Prices range from S$50 for the women-targeted screening kit that tests for yeast infection and bacterial vaginosis to S$200 for a cervical cancer screening kit.

WHY IT IS SELLING THE TEST KITS

Ms Liu said that regardless of age, sexually active individuals should undergo STI tests and sexual health checkups. For those who engage in high-risk sexual activities, frequent STI testing is recommended.

Through questionnaires on STIs and interviews with gynaecologists and people across Asia, Ferne Health found that there is a general lack of awareness on sexual health in the region, and Ms Liu hopes to change the way people in Asia take charge of their sexual health.

For instance, a recent sexual well-being questionnaire for Singapore women done by the firm found that half of the respondents have never taken a Pap smear or HPV test although they are past the recommended age of 30, she said.

Dr Vivek Manoharan, co-founder and chief scientific officer for Ferne Health, said that when detected early, the chance of preventing or successfully managing STI-related complications greatly increases.

“According to the World Health Organization, there is evidence that if given an option, the convenience of self-testing is attractive to consumers and would result in earlier and faster screening of STIs,” he said.

HOW TO USE THE TEST KITS

After ordering and receiving the selected self-sampling tool, users do the test at home following the instructions given in the kit.

If there are questions, say, on how to use the self-sampling tool, users may book a teleconsultation session with one of Ferne Health’s partner general practitioners.

After the sample is collected and tested at a lab, the results would be sent via email from a clinic within two to three days.

Ms Liu said that most tests require either a swab or urine sample, which can be easily collected at home. However, one of the kits testing for HIV, syphilis, and herpes 1 and 2 will require a blood sample.

To facilitate this, Ferne Health arranges for an on-site blood collection, which can be performed by a phlebotomist (a person trained to draw blood for clinical or medical testing, transfusions or research) at the patient’s home or other preferred locations.

The cervical cancer kit, which screens for high-risk HPV strains including HPV 16 and 18, requires a sample from the cervical area. High-risk HPV strains are associated with cervical, vaginal and vulvar cancer in women.

For this test, Ms Liu said that a sampling tool called the Evalyn Brush, which is approved by the Health Sciences Authority (HSA), is provided. It is being used in other countries as an at-home cervical DNA swab sampling method as well.

A consultation with a doctor from one of Ferne Health’s partner clinics is included with every kit purchase. If a test comes back positive, Ms Liu said that a doctor will have a teleconsultation with the patient to explain the results.

“This so that the patient will have a clear understanding of the results and can make informed decisions on any follow-up steps required. Some STIs need immediate treatment or specialist referral for follow-ups,” she said.

On the reliability and accuracy of the tests, Ms Liu said that all self-sampling tools used, such as brushes and swabs, are registered with HSA and imported by HSA-authorised vendors. Both sampling and testing protocols are clinically approved.

The tests are conducted in certified laboratories in Singapore, and the accuracy of the test results is equivalent to taking a screening test in a clinic, Ms Liu added.

HOW IS IT USEFUL

A check by TODAY with an infectious disease expert and gynaecologist revealed mixed views on home-based screening.

Adjunct Assoc Prof Chio of DSC Clinic said that self-testing options are useful especially when the patient is unable to access sexual health services due to various reasons.

Common reasons that patients give for not testing include lack of time, a busy work schedule, not wanting their boss to know, fear of knowing facing the truth, and so forth.

Adjunct Assoc Prof Chio said that tests done through self-sampling kits can increase the frequency of screening for people who have frequent partner change, and the upside is early detection and treatment to break the chain of transmission.

On whether easy access to home-based STI screening options will encourage more risky sexual behaviour, he said: “Gone are the days where the perception of (STI) screening equates reckless behaviour.

“It is heartening to observe that people are better educated, better aware of sexual health issues to empower themselves to screen regularly as part of personal and social responsibility; and soon, I hope it will be the norm with no stigma or discrimination.

“The option of self-testing will help encourage people concerned about stigma to screen for STIs as they won't need to spend time inside a clinic. (Doing) this may detect an otherwise missed STI, which may have led to transmission within the community,” he added.

WHAT THE RISKS ARE

There are potential risks and downsides to such tests. The accuracy of self-sampling screening tests depends on several factors, including whether the kit is from a reliable source, the timing of the test and the sensitivity and specificity of the test.

Adjunct Assoc Prof Chio said that he saw a 30-something patient last month who was diagnosed with an STI even though a test kit of an unauthorised brand that he bought from e-marketplace Carousell showed a negative result.

“He tested negative (with the kit bought off Carousell) but when I tested him at the National Skin Centre, his titres (levels) were very high and he was diagnosed with secondary syphilis. He had a rash that didn’t go away. At that stage, the kit should have picked up the infection.”

Dr Christopher Chong, a uro-gynaecologist, obstetrician and gynaecologist at Gleneagles Hospital, said that users must be aware that there may be false positive and false negative results.

“False positives can cause unhappiness, panic, overtreatment and even relationship problems.

“False negative is worse than false positive — failure to diagnose can cause deterioration of the condition and makes subsequent treatment more difficult. It can give people a false sense of security and cause disease spread, when one is really suffering from the disease,” Dr Chong said.

Different STIs have different incubation periods. Dr Chong pointed out, for example, that HIV may manifest three months after exposure, and being falsely cleared of the disease can lead one not to take precaution and increase the risk of infection.

Adjunct Assoc Prof Chio said that a test kit should be registered for self-testing and ideally be approved by HSA with a good track record in Singapore and overseas.

He advised users to do their due diligence to check HSA’s website to avoid being scammed when buying test kits from online sources.

“The sensitivity and specificity of the tests kits will vary from kit to kit. Sampling error is also possible if there are no detailed instructions provided with the kit on exactly how to collect the sample,” he said.

“The transportation of the kit to the respective laboratory should be secure so as to maintain the privacy and confidentiality of the patient; storage and transport temperatures, too, considering the tropical weather and also ensuring specimens don’t get lost or thrown away by mistake.”

Both Dr Chong and Adjunct Assoc Prof Chio advised people to seek medical care as soon as possible instead of waiting if they notice symptoms or suspect that they are at risk of getting STIs.

Dr Chong said: “If one suspects an infection, it is always best to see a doctor as good history taking and a physical examination are an essential part of good medicine. This also helps pick out other medical issues, especially for those who do not do regular wellness checks.”

He added: “In general, when it comes to medical conditions, it is best to leave it to the doctors. (Home-based testing) may be of some use in a very bad situation such as a lockdown period for Covid-19; then we have no choice and it is better than nothing.

“But I feel that it should be used as the last resort under special or unforeseen circumstances.”

Read next: I used a home screening kit for cervical cancer and this was how it went