A clinic in Cherry Creek recently stopped allowing male patients to swab themselves for sexually transmitted infections, raising concerns that gay and bisexual men could forgo testing, even as rates of certain infections have jumped.
Sean O’Connor, a patient who lives in Denver, said UCHealth’s Cherry Creek location was a particularly valuable resource, because it allowed people to have a “standing order,” meaning they didn’t need to see a doctor for a referral to test every time they had a possible exposure.
The process was convenient, he said: Patients would receive one swab for the throat and one for the rectum, and could be done taking their own samples in minutes.
With the rule change, patients who need that testing have to schedule an appointment with a provider who will swab them, which is both less convenient and more intrusive, O’Connor said.
“They’re doing their best to get people in, they just don’t have the capacity,” he said.
The machine that analyzes the swabs only allows self-swabbing of the vagina, and labs don’t have the option to ignore the manufacturer’s instructions, said Dan Weaver, spokesman for UCHealth.
The manufacturer tests its machines under specific protocols, and the U.S. Food and Drug Administration then determines that the machine works if the end user follows those directions. It can’t guarantee the results will be accurate under other conditions, so when someone realized that the machine wasn’t tested for self-swabbing other body parts, UCHealth had to change protocols, Weaver said.
“We know this is disappointing for many patients, including those who may need ongoing testing. Excellent care for all patients is our priority, and we are committed to helping patients access (sexually transmitted infection) testing as conveniently as possible,” he said in a statement.
Skylar Patron, health equity manager for the LGBTQ group One Colorado, said they and their colleagues are assessing whether the change will create a hole in the testing landscape around Denver.
A program run by the Colorado Department of Public Health and Environment allows patients to self-swab multiple orifices using a home testing kit, though only about 2,500 people ordered the kits last year.
Swabbing the site where a person had sexual contact can detect chlamydia and gonorrhea. In some cases, swabbing isn’t necessary: People who had sexual contact via the penis or vagina can just give a urine sample. Some other infections, including HIV, syphilis and hepatitis viruses, require a blood test for diagnosis.
Antibiotics generally can cure chlamydia and gonorrhea, though cases of drug-resistant gonorrhea have started to spread in other parts of the country. Both infections can cause pain, discharge from the area where the bacteria entered and possibly fertility problems, particularly if a person with an asymptomatic case never got treatment.
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The Centers for Disease Control and Prevention determined self-collected swabs were an “acceptable” means of testing men who have sex with men for chlamydia or gonorrhea in its 2021 guidelines.
A small study at a community health center found that patients and their providers preferred rectal self-swabbing, and that all but one of 33 patients who attempted it collected a sufficient sample to determine if they had chlamydia or gonorrhea.
O’Connor said he hopes UCHealth finds a new vendor whose system allows for the return of self-swabbing, particularly because rates of certain sexually transmitted infections have climbed in Colorado and nationwide in recent years. In 2023, the most recent year with county-level data, Denver counted 6,098 infections with chlamydia and 2,428 with gonorrhea.
“We need to increase access and decrease the stigma around being tested,” he said.
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