With doctor's appointments both hard to get and costly, could testing from the comfort of your own home help break down barriers to getting checked for sexually transmitted infections?
All other measures notwithstanding, it turns out New Zealanders aren't great at having safe sex.
Crown research institute ESR reported that syphilis case numbers increased by 41 percent last year, from 99 cases in the first quarter of 2022 to 140 in the fourth quarter.
And these are just the reported cases – the real number of cases in the community could be even higher, says Dr Beth Messenger, national medical adviser for Family Planning.
Left untreated, syphilis can cause heart and brain damage. There were six babies born with congenital syphilis in 2022, meaning the disease was passed to them in pregnancy – a potentially fatal condition.
"Anytime we see a rise in numbers, we're always worried about the infections that we haven't yet seen and treated. It's a bit of an indicator that things aren't well in our health system."
Cases of gonorrhea and chlamydia are also ticking upward again after transmission dropped while Covid-19 restrictions were in place.
These STIs are all treatable – but only if they're detected.
And Messenger says there are still some people who face barriers to getting tested.
"The vast majority of testing is still requested through a health practitioner ...you have to get to an appointment. There may be a charge, particularly for people who are over 25. There can be a wait to get an appointment, just because of the pressure on the health system at the moment."
She tells The Detail that people calling into Family Planning are currently facing a wait of several weeks to get an appointment.
To keep up with the demand on their services, Family Planning offers a 'quick test' for STIs – a swab or urine test that people can do by themselves, without seeing a clinician at all.
But, Messenger explains, without talking to a health professional about your symptoms or results, there's a risk that people with an STI won't get the support they need. There's a small number of people who find out that they've tested positive and then become "very, very difficult to contact again" to arrange treatment, meaning they could be continuing to spread sexually transmitted diseases.
Gary McAuliffe, a microbiologist specialising in testing, says the use of rapid antigen tests during the Covid-19 response "disrupted" the way we think about testing.
"In laboratories, we were struggling with the volume of Covid tests that we had to do during the Omicron outbreak. But by bringing that out to the people, you could scale up 10, 100 times the amount you could do. It's similar with sexual health testing."
McAuliffe sees a lot to be gained from making self-testing for STIs more widely accessible, particularly for at-risk groups like under-25s, men who have sex with men, and Māori and Pasifika people.
There are some groups in New Zealand that sell or supply self-test kits for STIs like syphilis, HIV, gonorrhea and chlamydia. with packages delivered direct to the door, and results kept anonymous and confidential.
While some test kits require samples to be posted away to a laboratory for processing, McAuliffe describes how some tests available now in New Zealand take a prick of blood or saliva swab and are able to deliver results within minutes.
But McAuliffe says ramping up testing efforts – and turning up more positive cases of STIs – needs to go hand-in-hand with increased resourcing on the other end of things: treatment.
"If you test positive for syphilis, what are you going to do about it? You don't want to just sit in your house and go, 'Oh no'," he says.
"We want to be able to link you into care ... [clinics] will need the resources, because we will be picking up a lot more people, because we will be casting the net wider."
To find out more about the possibilities and challenges of self-testing, listen to the full episode.
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