Everlywell vs. Shameless Care STI Testing: What Patients Should Know

Everlywell is a large telehealth and at-home testing company offering services across a broad range of healthcare categories. Shameless Care is more narrowly focused on sexual health.

For this comparison, we are looking specifically at sexually transmitted infection testing.

There are several important similarities between the two companies.

Both Everlywell and Shameless Care are LegitScript certified. Both companies also use CLIA-certified laboratories for applicable laboratory testing. Everlywell states that all laboratories processing its tests are CLIA-certified, with some also holding CAP accreditation.

Everlywell also provides access to clinician follow-up for certain positive STI results and says treatment may be available when applicable.

There is also an important point on which Everlywell and Shameless Care clearly agree:

A urine gonorrhea or chlamydia test cannot tell you whether gonorrhea or chlamydia is present in the throat or rectum.

Everlywell acknowledges this limitation in its own educational materials and describes oral and other swab testing as methods used to identify infection outside the urinary tract.

That is an important and medically responsible disclosure.

What does Everlywell test for?

Everlywell's primary mail-in At-Home STD Test currently costs $169 and screens for:

• Chlamydia – Genital Only
• Gonorrhea – Genital Only
• Syphilis
• Trichomoniasis
• Hepatitis C

The test uses urine and finger-prick blood specimens.

Everlywell also offers a separate Chlamydia & Gonorrhea Test for $69. It uses a urine specimen.

Everlywell sells OraQuick at-home HIV testing separately for $49.

For women, Everlywell also sells the Visby Rapid PCR At-Home Female STD Test for $149. It uses a vaginal specimen and tests for:

• Chlamydia – Genital Only
• Gonorrhea – Genital Only
• Trichomoniasis

The Visby test produces results at home in approximately 30 minutes.

Who does Everlywell say its testing is for?

This is where the comparison becomes more meaningful.

Everlywell describes its five-panel STI testing as being for people with new or multiple sexual partners and unprotected sex.

We believe people in those circumstances are usually trying to answer a broad question:

Do I have an STI that I could transmit to someone else?

They are probably not specifically asking whether they have Chlamydia – Genital Only, Gonorrhea – Genital Only, trichomoniasis, hepatitis C or syphilis.

We spend a lot of time thinking about STI testing, individual infections and anatomical sites. The average person does not. Most people simply want to understand their STI status.

People commonly say:

“I took an STI test and I’m clean.”

They generally do not say:

“I took a limited test made up of five selected infections, and those were negative.”

A patient can receive five negative results and reasonably walk away believing they have been broadly screened for sexually transmitted infections, even though several important infections and anatomical sites were never tested.

That does not make the tests inaccurate.

It means the scope of the testing may be substantially narrower than the patient’s understanding of what an “STI test” represents.

Patients choosing Everlywell should also understand what they are not being tested for, but that is true of any STI panel purchased to understand infection status.

The biggest difference: anatomical-site testing

The most meaningful difference between Everlywell's standard mail-in STI testing and Shameless Care is where the patient is tested.

Everlywell's standard at-home testing checks:

• Chlamydia – Genital Only
• Gonorrhea – Genital Only

Its Chlamydia & Gonorrhea Test specifically uses urine collection.

Gonorrhea and chlamydia can be site-specific.

A person can have gonorrhea in the throat while testing negative genitally. A person can have rectal chlamydia while testing negative genitally.

Testing one anatomical site does not determine the infection status of another.

At Shameless Care, we chose to include anatomical-site testing because we do not believe patients should be expected to already understand that gonorrhea and chlamydia may require separate testing of the genitals, throat and rectum.

Our internal testing data have reinforced that decision.

In a recent review of gonorrhea-positive cases at Shameless Care, approximately 86% were positive only at the oral site.

Those patients had gonorrhea detected in the throat while their genital testing was negative.

If those patients had received only Gonorrhea – Genital Only testing, the test performed at that site would have been negative even though gonorrhea was present elsewhere in the body.

A laboratory can accurately report:

Gonorrhea not detected in this specimen

while the patient still has gonorrhea at an anatomical site that was never sampled.

Comparing the panels

We do not know why Everlywell selected these particular infections for its primary at-home STD panel, and we do not want to speculate.

We can, however, compare what the products actually test.

Everlywell's primary at-home panel costs $169.

Shameless Care's most comprehensive testing costs roughly $100 more, but it also tests substantially more infections and anatomical sites.

On a simple per-test basis, Everlywell's $169 five-panel works out to about $33.80 per test, while Shameless Care's $269 14-panel works out to about $19.21 per test.

The two products are not directly comparable on price alone.

Everlywell's panel is less expensive, but it also includes fewer infections and anatomical sites.

It includes hepatitis C while excluding HIV and hepatitis B. Everlywell offers HIV testing separately through products such as its OraQuick At-Home HIV Test.

There is nothing inappropriate about screening for hepatitis C. It is an important infection. But patients should understand exactly what is—and is not—included.

A practical example

Consider two people entering a new relationship.

They decide that after both receive STI testing and negative results, they will stop using condoms.

Suppose each person purchases Everlywell's most comprehensive standard at-home panel and receives negative results.

They know the following were negative:

• Chlamydia – Genital Only
• Gonorrhea – Genital Only
• Syphilis
• Trichomoniasis
• Hepatitis C

But that panel has not told them whether they have:

• Chlamydia – Oral
• Chlamydia – Rectal
• Gonorrhea – Oral
• Gonorrhea – Rectal
• HIV
• Hepatitis B

That does not mean every person requires every possible STI test.

But a negative five-test panel should be understood for what it is:

negative results for the infections and anatomical sites that were actually tested.

One Everlywell statement we would correct

In Everlywell's educational article “How to Test for Gonorrhea”, the company describes oral-swab testing and states:

“there is no oral gonorrhea test you can take at home.”

That statement is not accurate.

Patients can self-collect throat swabs at home and send those specimens to a laboratory for gonorrhea testing.

A more precise statement would be:

Everlywell does not currently offer at-home throat gonorrhea testing.

This is a relatively small point, but there is a difference between one company not offering a test and that testing method not being available.

Why Shameless Care approaches this differently

Our approach was shaped in part by a personal experience of Shameless Care's founder.

Before Shameless Care existed, I purchased an STI panel from an online testing provider.

The panel included gonorrhea and chlamydia—or at least that is how I understood it.

At the time, I did not know that separate oral and rectal gonorrhea and chlamydia testing existed.

I saw gonorrhea listed as something I was being tested for. My result was negative, so I interpreted that result to mean:

I don't have gonorrhea.

But gonorrhea was present at an anatomical site that had not been tested.

Because I trusted the negative result, I subsequently transmitted the infection.

The laboratory had not necessarily made an error. The problem was that I did not understand the limitation of that test at the time.

That experience became one of the principles behind Shameless Care:

Patients should not need expertise in STI diagnostics before purchasing an STI test.

The Shameless Care approach

Shameless Care's panels are designed around both the infection and the anatomical site.

Depending on the panel selected, testing can include:

• Chlamydia – Genital
• Chlamydia – Oral
• Chlamydia – Rectal
• Gonorrhea – Genital
• Gonorrhea – Oral
• Gonorrhea – Rectal

along with additional infections included in the selected panel.

Our position is that patients should understand the scope of the testing they are purchasing and what their results actually tell them.

For many asymptomatic consumers, the question they are ultimately trying to answer is:

Do I have an infection that I could unknowingly transmit to my partner?

The Bottom Line

Everlywell is a legitimate healthcare company. It uses CLIA-certified laboratories for applicable mail-in testing, provides clinician oversight and follow-up for qualifying results, and publishes information explaining the limitations of testing only certain specimen types.

Our difference is primarily one of scope.

Shameless Care has chosen to offer broader infection coverage and multisite gonorrhea and chlamydia testing.

Patients comparing the two should look beyond the words “STD test” and beyond the headline price.

The questions that matter are:

Which infections are being tested? Which anatomical sites are being tested? And what does a negative result actually tell me?