Uncovering the pediatrician's role in OTC STI testing, with Lea Widdice, MD

Lea Widdice, MD, director, Adolescent Medicine Fellowship; associate professor, University of Cincinnati Department of Pediatrics, Cincinnati, Ohio.

During the 2025 Pediatric Academic Societies Meeting, Lea Widdice, MD, presented on "Know Your Role in OTC STI Testing." Widdice is director of the Adolescent Medicine Fellowship and associate professor at the University of Cincinnati Department of Pediatrics in Cincinnati, Ohio.

Read below for a Contemporary Pediatrics exclusive interview with Widdice about her presentation and the importance of accessibility to over-the-counter STI tests.

Contemporary Pediatrics: As over-the-counter STI tests become more accessible, how do you see the pediatrician’s role evolving in terms of adolescent sexual health education and counseling?

Lea Widdice, MD: Pediatricians will continue to be a source of positive sexual health education and counselling to patients and parents as over-the-counter STI tests become available. Pediatricians can be a source of information about the signs and symptoms of STIs, as well as the American Academy of Pediatrics’ recommendations for screening for STIs and prevention of STIs.

Pediatricians should be aware that most OTC STI tests will be marketed to consumers without mention of public health recommendations for whom should be screened, when screening should happen, and what organisms are pathogenic versus nonpathogenic. If patients present with results from unnecessary testing, the physician can respond to the results based on the test’s instructions for use.

Contemporary Pediatrics: What are some of the biggest opportunities—and challenges—you see with adolescents using OTC STI tests without provider involvement?

Widdice: Testing for STIs without a doctor’s involvement introduces opportunities to get tested to people who may not be able to or want to access medical care due to cost, lack of transportation, lack of time, shame about sexual activity, or concerns for loss of confidentiality. Increased access may lead to quicker treatment of infections, thus reducing the overall burden of STIs in the community.

Having OTC STI tests for sale on the shelves and advertised online may lead to increased recognition of STIs as a health concern and may help make screening and testing for STIs normalized. Even without purchasing the products, parents can use the presence of the OTC tests in the stores as a way to prompt age-appropriate discussions with their children about sexual health and their family’s values about sexual activity.

Many adolescents may feel more comfortable discussing their sexual health and questions about STI testing and STIs with their doctor instead of buying an OTC test. Patients and their parents may raise more questions with their doctor about their sexual health because companies promote testing for a wide range of organisms without regard to public health STI screening recommendations, and promote testing when testing is not medically necessary, as well as for organisms that are not pathogenic.

The terms of use and agreements required to use portals for online testing should be carefully read and considered by all consumers, but especially by adolescents. Companies will have access to the consumer’s personal information and testing history, as well as the consumer’s biological samples that contain DNA. The company’s terms of use may include access to consumers’ contacts and social media information. There are examples of terms-of-use contradicting statements on the web pages offering the testing. Consumers should pay careful attention to what they agree to regarding access to their information, how their information will be used, stored, and sold both now and if the company gets sold or goes bankrupt. Consumers should also understand clearly what the company will do with the biological samples they are sending to the company.

Contemporary Pediatrics: How can pediatricians support confidentiality while also encouraging teens to engage in follow-up care when they use at-home STI testing kits?

Widdice: If an adolescent presents to a medical visit with results from an OTC STI test, the doctor should respond to the results based on the test’s instructions for use. In general, positive results from the currently available OTC HIV and syphilis tests require confirmatory testing, so doctors should facilitate testing as they would for patients who need to be screened or tested for HIV and syphilis. Positive results from currently available chlamydia and gonorrhea OTC tests should prompt treatment; positive results do not need confirmatory testing before treatment is prescribed. Pediatricians can review the practice’s policies and procedures to maintain confidentiality for patients. 

Contemporary Pediatrics: In your experience, how do factors like stigma, access, and education impact adolescents' willingness to use or discuss OTC STI tests?

Widdice: In my clinical experience, the adolescents who have used and asked about OTC STI testing are older adolescents and young adults, well-educated about sexual health and STI prevention, and care about their health. They access OTC testing for the ease and convenience of getting tested and consider the OTC testing to be a supportive adjunct to the care they receive from me.

Contemporary Pediatrics: What advice would you give to fellow pediatricians looking to proactively integrate conversations about OTC STI testing into routine adolescent care?

Widdice: In addition to considering if their patients have received STI testing at other doctors’ offices, emergency department or an urgent care, pediatricians can also consider if their patient has used OTC testing. For older adolescents who are familiar with STI screening recommendations, conversations about the availability of OTC testing could happen during discussions of preventive services or sexual and reproductive health. For younger patients who don’t need STI screening, the conversation could happen when providing anticipatory guidance about sexual activity and upcoming preventive services.