As society reopens, officials in Los Angeles, Washington, D.C. and even rural Idaho are mailing thousands of free HIV test kits to people who request them online — and are starting to do the same for STDs. With gonorrhea, chlamydia, syphilis at record high rates, the officials say new self-swab and finger-prick testing options that patients mail to labs could ease pressure on strapped public health clinics, still consumed with the coronavirus crisis, that also bear the burden of more routine disease surveillance.

Washington, D.C.'s city government has shipped nearly 2,000 STD test kits since last summer and reports a roughly 6 percent positivity rate among those returned — significantly higher than in-person clinics were reporting before the pandemic. Many of those individuals had not been tested before and weren’t showing symptoms...

But regulatory obstacles and concerns over cost and human error could keep the at-home tests from becoming the new norm. Most tests designed for at-home sample collection haven’t been authorized by the Food and Drug Administration. And their effectiveness hinges on patients figuring out how to use them. Samples that sit too long in the mail or are exposed to either very hot or very cold temperatures could yield false positives, or worse, not detect actual cases. And while some health departments are contracting with established test-makers and private labs, the online market for STD tests has become a wild west, with startups making unsubstantiated claims as they market directly to patients.