NEW YORK (Reuters Health) - Enabling people to submit urine samples by mail to test for sexually transmitted diseases (STDs) could help diagnose infections in people who do not visit STD clinics, researchers report.

Taking a urine sample and dropping it in the mail requires effort, study author Larry Hanbrook of the San Francisco Department of Public Health told Reuters Health, but it's "so much easier than going to the clinic," he said.

Hanbrook, along with Dr. Jeffrey D. Klausner of the San Francisco Department of Public Health and colleagues, reported findings from a dry run of mail-in, free screening for chlamydia and gonorrhea in one San Francisco neighborhood. Participants picked up test kits at a pharmacy and at a gym.

Over a 2-week period, people picked up 209 test kits, and 80 of them collected urine samples and mailed them to the San Francisco Department of Public Health--a response rate of 38%.

Among returned samples that were tested for the STDs, three were positive for gonorrhea and one for chlamydia. In total, 5% of tested samples came back positive for either STD.

That infection rate is higher than what is seen in the general population, Hanbrook said, perhaps indicating that the test had reached the people who needed it most, such as those who were already experiencing symptoms.

While people with chlamydia or gonorrhea often have no symptoms, symptoms that do occur include vaginal or penile discharge and pain during urination. Both STDs can lead to a variety of serious conditions including pelvic inflammatory disease, infertility and ectopic pregnancy, which occurs when an embryo implants outside the uterus. The infections also facilitate the spread of human immunodeficiency virus (HIV).

However, both chlamydia and gonorrhea can be diagnosed with a simple urine test and treated with a course of antibiotics.

Studies based in the UK and Denmark have already demonstrated the feasibility of STD screening by mail in those regions.

The report, presented in the May issue of Sexually Transmitted Diseases, focused on individuals living in the Castro, a San Francisco neighborhood occupied predominantly by homosexual men. Ninety-five percent of the study participants were gay white men.

The testing kits were made available at a Walgreen's Pharmacy and a Gold's Gym in August 2000. Klausner and his team placed ads in a local gay newspaper, and posted fliers in areas near the pharmacy and gym.

Since mail-in STD screening removes any opportunity for education or counseling, Klausner and his team suggest that screening by mail should be thought of as a supplement to STD diagnosis and treatment at STD clinics, rather than a replacement.

However, study participants filled out a questionnaire as part of the project, in which some noted that they had avoided screening at STD clinics, which can have inconvenient hours and long waiting times. Hanbrook said he is "sure" that mail-in screening reached some people who would not otherwise visit an STD clinic.

Home-based screening is "a lot easier, and it fits into their lives more easily," he said.

SOURCE: Sexually Transmitted Diseases 2002;29:294-297.

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