Listen as I interview myLab Box founder Lora Ivanova about why sexually transmitted diseases are on the rise, why no one is getting tested, and how her business model is poised to change how we have sex and manage our health forever.
Countless non-profits and government agencies have struggled to permanently turn around rates of sexually transmitted diseases — with little lasting success. But a new startup headed by two female Millennials may be the answer.
myLAB Box is an at-home diagnosis testing that promises accurate testing for sexually transmitted infections for the anonymous privacy of your own home — and for the same or lower cost than going to a physician's office or laboratory. Co-founders Lora Ivanova and Ursula Hessenflow have raised more than half a million dollars in seed funding to bring to market what it says is the most comprehensive home STD testing service in the United States — a service that could move the needle on a massive public health issue, as well as tap into a profitable market.
Last year, the Centers for Disease Control and Prevention's STD surveillance report announced that the rates of chlamydia, gonorrhea, and syphilis — the three most commonly reported STDs in the nation — jumped between 2014 and 2015, reaching an all-time high. During that period, syphilis rose by 19 percent, gonorrhea by 12.8 percent, and chlamydia cases rose by 5.9 percent — all diseases treated by antibiotics.
Meanwhile, nearly half of Americans between the ages of 18 and 59 are infected with genital human papillomavirus, or HPV, according to the National Center for Health Statistics, which notes that high-risk strains of this sexually transmitted disease are carried by 25 percent of men and 20 percent of women, and cause about 31,000 cases of cancer each year. Genital herpes affects one in six U.S. adults under age 50, and while HIV diagnoses overall are down, they jumped dramatically between 2005 and 2015 for black and Latino gay men — and youth in particular. Overall, it is estimated that half of the U.S. adult population will be infected by at least one STD.
Failure to stem these infections includes lack of sex education, the cost, shame and inconvenience of regular testing, that sexually transmitted disease still carries great taboo. Plus, the sudden prevalence of online dating means that people are sleeping with people far outside their natural social circles, and disease follows. MyLAB Box addresses all of these issues.
“Most people are not talking about STDs, and if we're not talking about it, we're not getting tested,” said Ivanova, who points out that about 80 percent of people infected with STDs may not display symptoms. “Today, in 2017, this part of our lives is so far behind. It is time we catch up with the advances of technology and e-commerce.”
MyLAB Box tests for individual diseases start at $79, and go up to $399 for a full schedule of STD tests — rates Ivanova says are about half of what you would pay for in a doctor's office, without insurance. “Not only is going to a doctor's office more expensive, but it also takes more time, and people can feel embarrassed,” she says. “Plus, if you're tested in an office and pay with insurance, it is less private since your diagnosis is shared with the Insurance Information Bureau, which can affect your rates in the future — all of which prevents people from getting tested.”
MyLAB Box tests require users to collect samples by either urine, a swab, or a small finger prick of blood wiped on a paper. Mail in the kit, and receive an email with a link to a secure portal within eight days. The fee includes shipping, a specialized physician consultation and referral, if needed, as well as a prescription when appropriate — none of which come with the co-pay that are typical in a traditional physician-office experience.
Despite the seemingly obvious business opportunity and positive initial sales results, MyLAB Box has faced its unique challenges, Ivanova says. Potential investors (male), have made inappropriate comments to the female co-founders, such as, “So, which of you is infected?” (“We learned to laugh about it,” Ivanova says.), as well as being temporarily blocked from Google Adwords for being a sex toy vendor when an early promotion included sex lube. Twitter banned the company from its advertising program because, Ivanova says, it flagged the startup as a being a sex company, since myLAB Box did not fit into its categories or nonprofit organization, nor medical laboratory. “Public platforms have the power of sensorship, and can decide what messages can reach the public, and in some cases, the public suffers,” Ivanova says.
Is my LAB Box, based in Los Angeles, that can turn the tide, and change the conversation around sexually transmitted infection, and, ultimately culture around routine STI testing?
“Routine testing is not part of our culture because it is not easily accessible,” says Ivanova, who says that most people should test annually, including those in monogamous relationships, since infidelity is so common. If not in a monogamous relationship, but are sexually active, testing every 3 months is advised. “It is like teeth brushing — it only became part of our culture when it became easy and affordable to do it at home. If you had to go to the dentist every time you wanted to brush, it would never happen. By making things more comprehensive and accessible is how culture changes.”
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Full transcript of the interview with MyLabBox founder Lora Ivanova
Emma: Many people, myself included, are stunned to learn how prevalent sexually transmitted diseases are in this country. Some recent reports were out saying that 50 percent, nearly 50 percent of the US population has a sexually transmitted disease, and we are more sexually active than ever. Stunning, compelling, equally interesting I think, is today’s guest, Lora Ivanova, is an entrepreneur. She is co-founder of MyLabBox, mylabbox.com and it is a mail order STD testing service. She’s claiming that it’s highly accurate, it’s anonymous, extremely affordable, and it’s taking away all of the taboos, inconveniences, expenses, that come with going to your doctor, going to a laboratory, going to Planned Parenthood and getting a test. It is so compelling as a social service to me, as a business idea, and of course, I’m thrilled that it’s a female founder. Lora, thank you so much for being with me here today.
Lora: Thanks for having me, Emma.
“It is really difficult to really have conversations with partners about sexual health and when was the last time they got tested.”
Emma: Tell me a little bit about your company. It started in 2014, give me a brief background of how you and your co-founder got the idea and a little bit about your journey to where you are today
Lora: MyLabBox really came up as a result of two friends sitting together and talking and sharing experiences about their lives and the complicated situations that we sometimes, and our friends find ourselves in, living in a big city. We had not seen each other for a while. We were just catching up on what we had been up to and one thing led to the next, we just started talking about kind of our dating lives and how difficult it is to really have conversations with partners about sexual health and when was the last time they got tested.
The more we talked, the more we really realized that the issue wasn’t even so much in the matter of it being awkward or uncomfortable to talk about these things, the problem really was that the prevalent majority of people simply were just not nesting. If we’re not testing, we’re also not going to be talking about our sexual health. At the time it was 2014, it’s a contemporary day and age, and we really felt that this part of our lives had fallen so far behind that it was time for it to catch up to the future and really take advantage of the wonderful advances that technology and the e-commerce space have provided to us. We set off on a journey to create the US’s first, nationwide, at home screening service for STDs and we’re now really excited to be the most comprehensive service on the market; laboratories and doctor’s offices included.
Emma: Interesting. Give us an example of an STD test. What’s your most comprehensive test? How much does it cost? How does the whole process work?
Lora: The testing starts $79 for some of the individual tests. For example, a chlamydia/gonorrhea combo would be $79. You can order any test that we offer individually if you have a specific concern, or you can choose from three of our combo testing options. We call those our boxes. Our Safe Box is our entry level. Consider it testing for the biggest culprits. These are the highest risk STDs and the most common infections in the US today. That test is $189. The Uber Box, which is a step up from the Safe Box, is the testing level comparable to the screening that you would get in a clinic or a doctor’s office if you said test me for everything, and they actually did that. So you’re going to get your HIV, chlamydia/gonorrhea, you’re going to have your herpes, hepatitis, syphilis, etc. And the top test box is the Total Box, and this really is the most comprehensive package. It includes not only all the tests that you screen for in the physician’s office or a clinic, but it also includes things, for example, like, extragenital testing. Extragenital testing is detecting infections specifically in the mouth or rectal area. As many as 20 percent, if not more, of infections that occur in those areas, are localized, will not be detected with conventional methods. It also includes HPV, mycoplasma/ureaplasma and all the additional testing that is less common to be done in clinics, however, it’s also very important for us to screen for its part of this total comprehensive care package.
Emma: $269, how does that compare to how much it would cost you out of pocket if you went to a laboratory or your doctor?
Lora: It’s about half of what it would cost you out of pocket if you, for example, didn’t have insurance. What we’ve done with our testing is we’ve tried to price it affordable out of pocket regardless of whether you have insurance, because at the end of the day, using your insurance to pay for your STD testing means decreased level of privacy. The fact that you’re testing is shared with the insurance information bureaus, it becomes accessible for additional insurance providers and may affect rates in the future depending on your testing patterns. As part of our consideration for making this more private and giving you better control of your results, we’ve made this affordable out of pocket without the need to use insurance. If you do need and you do have a health plan, you can certainly request a reimbursement through them directly, and you can also use your FSA and HSA, your health saving account cards to pay for the testing direct.
Barriers to STD testing
Emma: It’s the cost, but for me and I think many people, you tell me, it’s not just the cost that’s the barrier of getting testing. It’s time. I think, for example, I need to find a new gynecologist. I don’t have any health concerns that I know of. I do get my STD test every year when I go for my annual exam. I just need to find a new doctor, and it is such a pain in the butt. I have to ask around, I have to make appointments, see if they take my insurance, most of them don’t because I’ve got this crummy insurance, then I have to take a lot of time out of my day to go. I’m super busy. All of these are barriers and I’m a couple months overdue of getting my annual exam, and I don’t even have a concern that might be very embarrassing and humiliating for a lot of people. You tell me, I can imagine how many barriers that you are overcoming by making this affordable, anonymous, at home, you mail it in, done.
Lora: There’s a lot of barriers, you’re absolutely right. And the thing is that is clearly is preventing people from getting tested. Less than half of adults in the US today have tested for anything other than HIV. We have so many other infections. I mean, HIV is just a tiny little fraction of the number of infections that occur every year. We’re talking about 20 million plus new infections every year, out of which HIV is I believe less than one percent. It really is coming to a point where it’s really obvious we need to change something and we need to make it convenient. Our cell phone service on average costs us about $100 a month, so you know, in two months bills you get a clean bill of health. It really is not that much if you compare to what we spend on lattes and some other things that we potentially don’t need, or on a night out, or a nice dinner. I mean, that’s really what it comes down to is getting the priorities back to where they really count and where they’re really protecting our health.
Benefits to mail order STD tests
You are right. The complicated landscape right now that exists with regards to testing requires not only to take time off of work to figure out where, and how, and schedule appointments. Also take half a day usually off of your busy schedule to go and sit in a waiting room, go through the process, wait another two, three, to four weeks sometimes to get results, not have any results on hand. Often times you get some sort of indication, we’ll call you if there’s a problem, but very few offices actually send you written results that you can share with partners or just have for your records. Last but not least, what happens if you are positive? That’s the biggest fear as well for many users. If you are positive then you have additional co-pays and you have to schedule additional visits, take more time off, whereas with MyLabBox we actually offer you complimentary telemedicine consultations with physicians in your state at no extra cost. So, if you do test positive, you know that the price that you pay to get tested is really all it’s going cost you not only for the screening but also potentially to get a prescription.
Emma: I love that. I’ll just share a quick anecdote and I think it happens all the time. A friend of mine, she didn’t have any reason to be worried but she just asked her physician at her annual exam to do a genital herpes test and he said, I’m not even going to bother because you have oral herpes. I don’t even know what the rest of the conversation was. It seems like there’s so much mixed differing information. With this, it’s just like you send the samples in and you get a factual answer back without any confusion.
Lora: Absolutely. Not every physician is equipped to address sexual health concerns. We often times ask questions in the wrong time, or we ask them to the wrong people. We sometimes talk to generalists and not to, for example, OBGYNs. Sometimes we talk to professionals who are more focused, for example, on treating fertility questions than STIs. There’s a very specific knowledge base that really makes it difficult for consumers to find questions, even when they are going to a professional. This is partially why we really feel is important to not only talk to STD counselors and have those on hand, but also have physicians that are specifically prepared to deal with the most up to date treatment, practices, and consultations around the STIs specifically.
Emma: Interesting. When we first met, you had this great quote. You said, “There have been so many non-profit organizations that have been trying to move the needle on STIs for a hundred years and nothing has worked.” Everyone loves to throw around the word disruptor, but this really could disrupt a millennial long issue, which is sexually transmitted disease. I think it’s just simply brilliant. Tell me about the business part of this. What kind of response are you getting from partners, from potential investors, marketing partners? How is this playing out there?
Lora: It’s been a very fascinating journey, and just a very exciting journey I think to be on for us. You are right, this is a disruptive model. It’s doing something that hadn’t been really attempted in the past and it’s showing some tremendous results, such as a high percentage of our users who are testing right now with this service who have never tested before, many of them are coming to us proactively, not because they’re testing for specific symptoms, or because they’re on alarm. It’s really kind of reshaping I think a lot of the taboos around sexual health care and around who really needs to be testing and should be testing for STIs, and how often.
How accurate is MyLab Box mail-in STD test?
Initially, when we started we were faced with a lot of skepticism, a lot of questions, a lot of, in some cases, ridicule. Some inappropriate questioning along the lines of which STD do we have, and how did we get inspired to start this company. It’s comical. We’ve learned to really laugh about it because I think there’s really no other way to look at it. The numbers are now there. We’ve been operating successfully and have been on the market for almost two years now. We launched our full panel of tests at the end of 2016 and we’re seeing some really stellar results with consumers online. Now, the tides have been turning. We’re capturing some incredible interest from investors and from potential partners. There’s quite a few exciting things in the works for us that we’re really itching to release and announce in the coming months. I think it’s exciting to see this, as you said. There’s a great saying, the definition of insanity is trying to get different results by doing something in the same way as you’ve always done before. This is what’s really turning the tides with us.
Emma: You’re turning the tides and the answer to the STD testing challenge, but you’re really asking us to change our culture. To make testing a part of our sexual health as a normal thing. As somebody who actively dates in New York City, where there’s a lot of dating going on, I am here to tell you it is not part of our culture. It is not at all. I mean, I don’t know if any guy has ever asked— one, and he was a physician. Before we slept together he asked me if I had any health concerns we needed to talk about. No one talks about it. I wonder if, that’s part of this. That would be phenomenal for your business if our culture included that conversation every time somebody hooked up.
Lora: I think it’s getting there. I think the reason why it hasn’t really been part of our culture, it’s because it hasn’t been easily accessible. I always give this example with brushing our teeth for example, with dental care. Brushing our teeth was not part of our culture at some point. It became part of our culture when we were able to do this easily and conveniently at home, and create a healthy habit. If we had to go to the dentist every time we had to brush our teeth, think about how many of us would actually be doing this today. STD testing has been that kind of ridiculous scenario where you literally had to go to the dentist to brush your teeth, every single time you needed to take care of something proactively. Just by being available, I think that the demand is there, people have been gaining awareness around STIs, obviously, condoms are being used, people are using protection, but we just need to make that protection more comprehensive and easily accessible so that it becomes an even bigger no-brainer as we move forward. I think that’s really how culture changes. It’s not so much sometimes the kind of uphill battle as much as just giving people the keys to the car so they can just start driving it.
Emma: Right. Can you give us an example of one of the craziest things that somebody has said to you when you have been sharing your business idea?
Lora: The question about STDs, we’ve gotten that a couple of times. Which one of us has the STD?
Emma: How do you respond? How do you answer that?
Lora: I think we made some sort of a joke about, both of us. Can you guess which one has what? Sometimes it’s a joke, it really depends on the circumstance. Sometimes it’s you just kind of push forward with the next response to a question, but I try to see this in good humor. At the end of the day, it’s not personal. I understand it is an uncomfortable topic to talk about and not everybody that we approach with it has the capacity and really knows how to handle that. As you said, sometimes even adults don’t know how to have certain conversations, and investors are very much regular people. Business partners are very much regular people who have their own biases and prejudices, and sometimes non-PC ways to express things.
Emma: You know what, I’m very interested in the marketing side of what you’re doing. I had Cindy Gallop on this show and she has, one of her projects is Make Love Not Porn. It’s consumer generated erotica, video, let’s say. She has a lot of challenges growing her business because PayPal won’t work with her because they can’t figure out that she’s not porn. Granted, what she’s doing is easily confused. Or I think about Miki Agrawal with her Thinx Panties, and she had a full on public war with the New York City Metro System, because they wouldn’t put her ads that show— She’s just so coy and has slices of grapefruit and made all these old dudes at the ad agency blush, so her ads got banned. It’s all these social norms in the marketing that are a challenge to get the messaging through. I’m wondering if that’s a challenge for your business too?
Business challenges in sex-related business
Lora: It absolutely has been a challenge. We very much share some of those same hurdles. We’ve had to take off products from our side. For example, we had, early on, kind of a lube as a bonus to some of the combo boxes when we launched our service, and we had to take it off of our site because we were being prevented from advertising, I believe at the time it was AdWords because Google was considering it a sex product site, because it had lube on one of the pages. We’ve resolved that since so our Google ads are now running successfully, but we’ve been restricted from some categories. For example, HIV testing advertising and other things that some of these platforms have put in place without really fully understanding the health landscape. For example, they allow laboratories and non-profits to advertise testing services, but because we are disruptor in the space, it’s a new model that didn’t exist in the past, they would initially not allow us to advertise because they didn’t know what to make of us. They would just say, are you a lab? We’d say we’re not, we’re doing something else. Well, are you a non-profit? Well, we’re not. It really kind of made it very difficult for us to get the initial word out.
Twitter shut down our ad account and I spent several months trying to make some internal headway with them to at least get an idea of why. Or at least have a conversation around what we do and educate them, and that was faced with a stone wall. To this day, we are not advertising with them and will not advertise with them due to that fact. We have found on the flipside also, partners that have been willing to work with us like Facebook and some other different channels.
At the end of the day I think, the unfortunate thing is public platforms like this now have, in a sense, the power of censorship. They can really decide and choose what messages reach the public. If sexual health is not a priority for them, or they don’t have the same level of awareness around what the significance behind it is, the entire public suffers. I think as a society we need to start holding these platforms a little bit more accountable about the news that they bombard us with and the information that they actually prevent us from accessing. Not to say that there’s no room for improvement across the board.
The other thing to be really kind of mindful, when we talk about sexual health, we’re not just talking about sex. We’re talking about children. We’re talking about generations that are affected by these infections that really don’t have a choice. It affects infant mortality, it affects a lot of aspects of our society that are beyond what may be considered some sort of level of promiscuity, or unsafe sex. It really is a lot more complicated than that. I think, hopefully, we will soon all kind of open our eyes, and so will also things like advertising channels and legislative bodies that will help us move the needle forward as well.
Emma: I have a couple technical questions. Why would somebody want to get a very specific test? I’m looking, you have chlamydia/gonorrhea or only get genital herpes. Why wouldn’t we all be getting all of them every few months?
Lora: One case, for example, would be if you had a positive result, often times you need to retest after a certain timeframe from the completion of your treatment, to make sure that the infection has been cleared. In some cases, it is because you have specific symptoms that are associated with one infection or the other. Maybe you have had a partner that tested positive for a specific infection and you want to test for that thing specifically. It’s a good way to kind of do a targeted test without having to incur the cost for panels that you may not be needing specifically at that time.
Emma: How does it work? Is it blood tests? Because a lot of these aren’t they traditionally blood tests?
Lora: The service and the collection process we have designed to be intentionally as pain-free and as easy and convenient as possible. A big portion of our test are actually based on urine specifically for the male customers. Literally, all they have to do is pee in a cup, they take a small sample of that, ship it back to us. For women, it is typically a vaginal swab, which is basically as easy as, if not easier than inserting a tampon. Then for our transgender audience, we also use urine collection. About less than third of our tests require a blood sample, and that is done with simply a finger prick. So, we don’t require you obviously to drain a vial of blood from yourself at home. You just prick your finger, you dab a few drops of blood on a piece of contact paper, and you send that piece of paper back to us, and we can run your entire test panel on the basis of that sample.
Emma: Wow. Okay, that is remarkable. Tell us, what is the general rule? If you want to educate people about sexual health, what would you want every adult person in this country to know and do?
Lora: I would love to see us as a society start to test regularly. Not when we actually have a symptom. As many of 80 percent of infections out there do not show any symptoms of existing. We may be living carefree. We may be doing visual inspections with partners, we may be using condoms and we may just be continually spreading those infections. Really the only key to flipping the tides of this mass epidemic, which now affects over half of our population, is just test periodically. If you are sexually active, no matter if you’ve had one partner or 20, or if you’ve had just oral sex or just anal sex, you are at risk of infections. Even heavy petting in some cases can transmit an infection. Being sexually active requires you to also be responsible and just take care of yourself. You wouldn’t want to have a cavity, why should you not take any precaution to contract something that’s even more dangerous for your health?
It is now easy, it is convenient. Testing every six months, once a year at least I would say, should be the common practice for anybody that’s sexually active, including people in many cases what is considered stable relationships. Unfortunately, in a world where everybody is kind of faithful to their partner, we would not need that, but that’s not really the case of reality. Even with marriages and stable couples, we do recommend periodic testing, because at the end of the day sometimes incubation periods mean that infections occur and appear later. Sometimes things happen and ultimately we do have responsibilities not only to our partners but to ourselves to know our status.
Emma: I think you told me the statistic was 20 percent in committed relationships infidelity.
Lora: These were statistics as of a couple of years ago. I think we may be seeing a different trend now as well. I think it was a little over 20 percent for men and around a little under 20 percent for women.
Emma: There was another study that was so interesting to me which was an uptick in syphilis infections linked to online dating?
Lora: Yeah, so there was a research study that was done, I believe it was called Tracing Syphilis Through Cyberspace, which is probably one of my most favorite titles for a research study ever.
Emma: Right? I imagine a syringe running through the universe chasing germs.
Lora: With sort of weird gamer fantasy.
Emma: Yes. Totally.
Lora: Tron. Tronnin’ with STDs. The finding was that meeting a partner online increases one’s odds of contracting an STI as many as three times. Obviously, there’s a lot more research that needs to be done in this area. From a very basic epidemiological perspective, the social circles and the way that they’re crossing now with the presence of online dating is a lot more complex than our society ever experienced in the past. You could potentially be dating the same circle of friends for 20 years in the past, now you have access to 20, 30, 50 of those circles and infections just like everything else can spread and jump from circle to circle much more easily. Once the infection is in that circle then it affects everybody in it potentially, depending on the kind of social patterns in that circle. We are seeing, and there’s significant not only evidence but also theoretical backup to the fact that online dating is changing the way that infections are spreading. I think we are seeing that in the statistics. It’s just a matter of time in my opinion until that direct correlation really is solidified.
Emma: That’s interesting. Okay, oh my goodness. I love your business story, I don’t love the sexually transmitted disease story. Maybe you’re going to be our superhero that’s going to single-handedly save us from ourselves.
Lora: I think our first we did all in animation of MyLabBox and it was a little box with a cape that was flying around and saving people from STDs, so we definitely our your STD superhero, as crazy as that sounds. We are here to protect you. Just let us take care of you. Trust us. Get tested and leave the rest to us.
Emma: I feel so cared for. You’re my STD mom.
Lora: Yes, the STD fairy. How bad does that sound? I’ll make all of your wishes come true.
Emma: Oh, no. Alright, Lora Ivanova, please check out her ads. They are all over Facebook. I have seen them. It’s mylabbox.com and I’m just very excited to watch you in this business because I think really big things are gonna happen. Congratulations.
Lora: Thank you so much, and I’ll see you at mylabbox.com
Emma Johnson is a veteran money journalist, noted blogger, bestselling author and an host of the award-winning podcast, Like a Mother with Emma Johnson. A former Associated Press Financial Wire reporter and MSN Money columnist, Emma has written for the New York Times, Wall Street Journal, Forbes, Glamour, Oprah.com, U.S. News, Parenting, USA Today and others. Her #1 bestseller, The Kickass Single Mom (Penguin), was named to the New York Post's ‘Must Read” list.
Emma regularly comments on issues of modern families, gender equality, divorce, sex and motherhood for outlets like CNN, Headline News, New York Times, Wall Street Journal, Fox & Friends, CNBC, NPR, TIME, MONEY, O, The Oprah Magazine and The Doctors. She was named Parents magazine’s “Best of the Web,” “Top 15 Personal Finance Podcasts” by U.S. News, and a “Most Eligible New Yorker” by New York Observer.