Acceptability of Self-Taken Vaginal Swabs and First-Catch Urine Samples for the Diagnosis of Urogenital Chlamydia trachomatis and Neisseria gonorrhoeae With an Amplified DNA Assay in Young Women Attending a Public Health Sexually Transmitted Disease Clinic

Maastricht University, Maestricht, Limburg, Netherlands
Sex Transm Dis (Impact Factor: 2.84). 09/2006; 33(8):491-5. DOI: 10.1097/01.olq.0000204619.87066.28
Source: PubMed


Public health efforts are needed to encourage young women to get tested for Chlamydia trachomatis (CT) and Neisseria gonorrhoeae (GC).
To assess the acceptability and feasibility of 2 noninvasive diagnostic approaches.
Participants of this cross-sectional survey were 413 young women (age 16-35) who underwent STD testing by self-taken vaginal swab (SVS) and a first-catch urine sample (FCU) by nucleic acid amplification test (BDProbTec) and filled out a questionnaire.
CT and GC were diagnosed in 10.9% (45/413) and 1.5% (6/413). Eleven percent of the participants who never previously had an STD examination (68%) tested STD positive. SVS and FCU were almost uniformly reported as easy to perform and preferred above gynecologic examination.
Using SVS combined with FCU can be an important enhancing tool in public health approaches. Acceptability among potential patients is high, enabling the noninvasive detection of STDs that would otherwise remain undetected and untreated.

Download full-text


Available from: Christian Hoebe, Nov 12, 2014
  • Source
    • "Women provided self-collected vaginal swabs and self-collected anorectal swabs, which studies have proven to be a generally acceptable, valid and feasible approach [3,24,25]. Trained study nurses provided women with a visual diagram and oral instructions about how to take separate self-collected vaginal and rectal swabs. For the vaginal swab, the patient was instructed to insert the swab 2.5 cm into the vagina, rotate it for 5 to 10 seconds, and then place it in a capped tube to avoid potential contamination. "
    [Show abstract] [Hide abstract]
    ABSTRACT: Background Symptom- and sexual history-based testing i.e., testing on indication, for anorectal sexually transmitted infections (STIs) in women is common. Yet, it is unknown whether this strategy is effective. Moreover, little is known about alternative transmission routes i.e. by fingers/toys. This study assesses anorectal STI prevalence and infections missed by current testing practice, thereby informing the optimal control strategy for anorectal STIs in women. Methods Women (n = 663) attending our STI-clinic between May 2012-July 2013 were offered routine testing for anorectal and urogenital Chlamydia trachomatis and Neisseria gonorrhoeae. Data were collected on demographics, sexual behaviour and symptoms. Women were assigned to one of the categories: indication (reported anal sex/symptoms), fingers/toys (only reported use of fingers/toys), or without indication. Results Of women, 92% (n = 654) participated. There were 203 reports (31.0%) of anal sex and/or symptoms (indication), 48 reports (7.3%) of only using fingers/toys (fingers/toys), and 403 reports (61.6%) of no anal symptoms, no anal sex and no anal use of fingers/toys (without indication). The overall prevalence was 11.2% (73/654) for urogenital chlamydia and 8.4% (55/654) for anorectal chlamydia. Gonorrhoea infections were not observed. Prevalence of anorectal chlamydia was 7.9% (16/203) for women with indication and 8.6% (39/451) for all other women (P = 0.74). Two-thirds (39/55) of anorectal infections were diagnosed in women without indication. Isolated anorectal chlamydia was rare (n = 3): of all women with an anorectal infection, 94.5% (52/55) also had co-occurrence of urogenital chlamydia. Of all women with urogenital chlamydia, 71.2% (52/73) also had anorectal chlamydia. Conclusions Current selective testing on indication of symptoms and sexual history is not an appropriate control strategy for anorectal chlamydia in women visiting an STI clinic. Routine universal anorectal testing is feasible and may be a possible control strategy in women. Yet costs may be a problem. When more restricted control measures are preferred, possible alternatives include (1) anorectal testing only in women with urogenital chlamydia (problem: treatment delay or loss to follow up), and (2) direct treatment for urogenital chlamydia that is effective for anorectal chlamydia as well.
    Full-text · Article · May 2014 · BMC Infectious Diseases
  • Source
    • "Two other studies reviewed found a high rate of agreement in C. trachomatis detection by NAAT for PV versus FCU or CS specimens [18, 19]. Several studies that evaluated PVS acceptability found that PVS was a highly acceptable and easy specimen collection strategy19202122. Gaydos et al used a novel strategy for chlamydia screening by PVS, which involved a Web site through which participants could request a PVS kit and obtain a questionnaire (via phone, email/Internet, or at a community center) [22]. "
    [Show abstract] [Hide abstract]
    ABSTRACT: In preparation for the 2015 Centers for Disease Control and Prevention (CDC) Sexually Transmitted Diseases (STD) Treatment Guidelines, the CDC convened an advisory group in 2013 to examine recent abstracts and published literature addressing the epidemiology, diagnosis, and management of STDs. This article summarizes the key questions, evidence, and recommendations for the diagnosis and management of uncomplicated Chlamydia trachomatis (CT) infection in adolescents and adults that were considered in development of the 2015 CDC STD Treatment Guidelines. The evidence reviewed primarily focused on CT infection risk factors in women, clinical significance of oropharyngeal CT detection, acceptability and performance of CT testing on self-collected specimens in men, performance of CT point-of-care tests, efficacy of recommended and investigational CT infection treatments, and timing of test of cure following CT infection treatment in pregnant women.
    Preview · Article · Dec 2011 · Clinical Infectious Diseases
  • Source
    • "Although current sampling methods, i.e., self-taken vaginal swab (SVS) and first catch urine (FCU), are easy to perform and well accepted [16], and treatment is simple (one dose of 1000 mg azythromycin), reluctance of at risk populations to attend appropriate care and fear of invasive gynecologic examination hamper effective STD control [16]. While adolescents and young adults may not feel at risk since CT infections are often asymptomatic (approximately 70% in women and 50% in men) [10,13,17,18], they have a high prevalence of unsafe sex and low STD testing rates [19]. "
    [Show abstract] [Hide abstract]
    ABSTRACT: Chlamydia trachomatis infection (CT) is the most prevalent bacterial STD. Sexually active adolescents and young adults are the main risk group for CT. However, STD testing rates in this group are low since exposed individuals may not feel at risk, owing-at least in part-to the infection's largely asymptomatic nature. Designing new testing environments that are more appealing to young people who are most at risk of acquiring chlamydia can be an important strategy to improve overall testing rates. Here we evaluate the effect of a school-based sexual health program conducted among vocational school students, aiming to obtain better access for counseling and enhance students' STD testing behavior. Adolescents (median age 19 years) attending a large vocational school were provided with sexual health education. Students filled in a questionnaire measuring CT risk and were offered STD testing. Using univariate and multivariate analysis, we assessed differences between men and women in STD-related risk behavior, sexual problems, CT testing behavior and determinants of CT testing behavior. Of 345 participants, 70% were female. Of the 287 sexually active students, 75% were at high risk for CT; one third of women reported sexual problems. Of sexually active participants, 61% provided a self-administered specimen for STD testing. Independent determinants for testing included STD related symptoms and no condom use. All CT diagnoses were in the high-CT-risk group. In the high-risk group, STD testing showed an increased uptake, from 27% (previous self-reported test) to 65% (current test). CT prevalence was 5.7%. Vocational school students are a target population for versatile sexual health prevention. When provided with CT testing facilities and education, self selection mechanisms seemed to increase CT testing rate dramatically in this high-CT-risk population expressing sexual problems. Considering the relative ease of testing and treating large numbers of young adults, offering tests at a vocational school is feasible in reaching adolescents for STD screening. Although cost-effectiveness remains an issue counseling is effective in increasing test rates.
    Full-text · Article · Sep 2011 · BMC Public Health
Show more