Accuracy and Trust of Self-Testing for Bacterial Vaginosis
ABSTRACT PurposeTwo point-of-care tests are available to detect bacterial vaginosis (BV), a common vaginal condition. This study aimed to (1) compare the accuracy of two self-performed BV tests with clinician-performed BV tests and with clinical diagnosis of BV; and (2) compare trust of results for self-performed BV testing with clinician-performed BV testing.Methods
Participants (14–22 years old) in a study assessing self-testing for Trichomonas vaginalis were also asked to perform a self-test for BV (using a pH or sialidase test). Results were compared with clinician-performed tests and with clinical diagnosis of BV (defined by modified Amsel criteria). A two-item subscale from a larger acceptability scale was used to assess trust at baseline, after testing, and after discussion of results.ResultsAll 131 women performed self-BV testing correctly. Agreement between self- and clinician-performed tests was good (κ: .5–.7) Compared with clinical diagnosis of BV, self-pH was 73% sensitive and 67% specific, and self-sialidase was 40% sensitive and 90% specific. Trust in self-performed BV testing was lower than trust in clinician-performed BV testing at baseline, but increased after testing and discussion of results.Conclusions
Young women can perform self-tests for BV with reasonable accuracy, which could increase testing when pelvic examinations are not feasible. Trust in self-testing increased after experience and after discussion of test results. Although the pH test is available over the counter, young women may continue to rely on clinicians for testing.
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ABSTRACT: Background. The secretory leukocyte protease inhibitor (SLPI) is responsible for regulating inflammatory damage and innate and adaptive immune responses of the vaginal mucosa. Depressed cervicovaginal SLPI levels have been correlated with both Trichomonas vaginalis (TV) and poor reproductive health outcomes.Methods. We measured levels of SLPI in 215 vaginal specimens collected from adolescent women ages 14-22. Log-transformed SLPI values were compared by ANOVA or by unpaired t test before and after adjusting for confounding effects through the propensity score method.Results. Women on hormonal contraceptives and those with abnormal vaginal pH had lower SLPI levels as compared to their peers. After propensity score adjustment for race, behavioral factors, hormonal use and other STIs, SLPI levels were lower in women with positive TV antigen test, pH>4.5, vaginal leukocytosis, recurrent compared to initial TV infection, and were lowest in those with highest TV load.Conclusions. SLPI was reduced by >50% in a TV load dependent manner. Future research should consider whether identifying and treating women with low levels of TV infection (before they become wet mount positive) would prevent the loss of SLPI and impaired vaginal immunity. SLPI could be used as a vaginal health marker to evaluate interventions and vaginal products.The Journal of Infectious Diseases 01/2013; DOI:10.1093/infdis/jit039 · 5.78 Impact Factor
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ABSTRACT: Abstract. Background: Clinicians and developers identify sensitivity as an important quality in a point-of-care test (POCT) for sexually transmissible infections (STIs). Little information exists regarding what patients want for STI POCTs. Methods: A qualitative study, encompassing five focus groups among attendees of STI and adolescent health centres in Baltimore, Maryland, and Cincinnati, Ohio, were conducted between March 2008 and April 2009. Discussion topics included advantages and disadvantages of having a POCT, perceived barriers to using POCTs in the clinic setting and at home, priorities for the development of new POCTs for STIs, and envisioned characteristics of an ideal POCT. All discussions were recorded and transcribed. A qualitative content analysis was performed to examine frequencies or patterns of recurring codes, which were regrouped and indexed to identify salient themes. Results: Patients attending STI and adolescent outpatient clinics are in favour of diagnostic tests that are rapid, easy to read and simple to use. Home testing options for POCTs were acceptable and provided better confidentiality, privacy and convenience, but clinic-based POCTs were also acceptable because they offer definitive results and ensure immediate treatment. Barriers to home POCTs centred on cost and the ability to read and perform the test correctly at home. Opinions did not differ by patient ethnicity, except that Hispanic participants questioned the reliability of home test results, wanted high sensitivity and desired bilingual instructions. Conclusions: Patients attending STI and adolescent medical centres are in favour of STI POCTs if they are affordable, rapid, easy to read and simple to use.Sexual Health 10/2013; 10(6). DOI:10.1071/SH13047 · 1.58 Impact Factor