There’s an app for that – October 2, 2013

Having worked in a sexual health clinic for so many years, I thought I had seen and heard it all, including imaginative self treatment for various bumps and secretions—following self-diagnosis. Only when these treatments repeatedly failed, would they come to the clinic, saying, “I researched it.”This usually meant they had done a Google search and landed in Wiki land. However, I applauded the do-it-yourself approach when a client told me she was using an app on her smart phone to chart her menstrual cycles (e.g., Justisse Charting App). I also approved heartily when some Public Health Units started using e-cards to inform infected partners they should get tested.

But an app for diagnosing sexually transmitted infections (STIs)? That’s where DIY may cross the line.

Wired Magazine interviewed the Swedish orthopedic surgeon who developed an app that would allow users to take pictures of suspicious spots on the skin (e.g., unusual moles) and send them for interpretation to a licensed dermatologist in Europe. One dermatologist interviewed on CBC about this technology dismissed it as highly unreliable for finding precancerous conditions. But while this may discourage some from using the app for serious dermatological problems, others have found a different use:  sending pictures of unusual spots on their genitals, specifically to diagnose STIs.

No doubt it’s important to be knowledgeable and sensitive to changes in one’s body, but also clear-eyed enough to know when to see a health-care provider. And we need to encourage people to see a professional when there is any change in the appearance of the genitals or their secretions. But when even health-care providers can be fooled by infections like syphilis, which has been called “the great pretender,” we need to question the usefulness of this method of diagnosis. The STI app claims, according to the article, to allow people to “spot syphilis, genital warts, herpes, and other sexually transmitted infections.”

This seems a rather far fetched promise. Suppose the doctor who receives the photo responds, “don’t worry; it will go away”?

STI symptoms may resolve on their own, but the infection may remain. For example, syphilis chancres, which are painless lesions, disappear as does a syphilis rash. However, this does not mean the infection is gone. Syphilis may remain latent for years, eventually attacking the body’s organs and nervous system.

A herpes sore also disappears (at least till the next time). So though one could guess that a recurring sore in the same spot might be herpes, the best way to diagnose and type its strain is by having a health-care provider take a swab, not by pointing your cell phone camera at it. It is important to determine the type of herpes infection present, because genital herpes (as indicated in earlier blogs) may be caused by unprotected oral sex by a person with a history of cold sores (HSV-1).  It is a lot less likely to pass on this type of herpes genitally than to pass on HSV-2; and it recurs less frequently. This is a clear case of a picture speaking less than a thousand words.

Moreover, diagnosing an STI is only one part of the process. Being sure the proper diagnostic tests are done, counselling and educating a person with an STI, treating them with the correct medication as well as encouraging them to tell their partner(s) are all part of the services offered by health-care providers.

A person newly diagnosed with herpes, for example, may feel shocked and stigmatized; important information about transmission may not sink in. They may need to return for further counselling. By the same token, clients who are told they have warts, caused by Human Papillomavirus (HPV), may be terrified they will get cancer which is, of course, unlikely [See my article on HPV]. The STI app surely cannot provide these important services to those feeling alarmed by what they’ve seen and photographed.

So, while there is plenty of good information and there are plenty of tools out there, let’s be rational, and inventive. The takeaway message? If there is a fire down below or anything that concerns you, get it checked out—in person.

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