Self-sampling for oropharyngeal and rectal specimens to screen for sexually transmitted infections: acceptability among men who have sex with men

Wayal, Sonali; Llewellyn, Carrie; Smith, Harry L.; Hankins, Matthew; Phillips, Alan; Richardson, Daniel; Fisher, Martin

doi:10.1136/sti.2008.032193

Cited by 58 publications

(59 citation statements)

References 26 publications

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“…gonorrhoeae, compared to clinician-collected specimens (15,16). This affords the possibility of testing MSM for STIs in nonclinical settings, including home sampling.…”

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confidence: 99%

The “3 in 1” Study: Pooling Self-Taken Pharyngeal, Urethral, and Rectal Samples into a Single Sample for Analysis for Detection of Neisseria gonorrhoeae and Chlamydia trachomatis in Men Who Have Sex with Men

et al. 2016

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c Triple-site testing (using pharyngeal, rectal, and urethral/first-void urine samples) for Neisseria gonorrhoeae and Chlamydia trachomatis using nucleic acid amplification tests detects greater numbers of infections among men who have sex with men (MSM). However, triple-site testing represents a cost pressure for services. MSM over 18 years of age were eligible if they requested testing for sexually transmitted infections (STIs), reported recent sexual contact with either C. trachomatis or N. gonorrhoeae, or had symptoms of an STI. Each patient underwent standard-of-care (SOC) triple-site testing, and swabs were taken to form a pooled sample (PS) (pharyngeal, rectal, and urine specimens). The PS was created using two methods during different periods at one clinic, but we analyzed the data in combination because the sensitivity of the two methods did not differ significantly for C. trachomatis (P ‫؍‬ 0.774) or N. gonorrhoeae (P ‫؍‬ 0.163). The sensitivity of PS testing (92%) was slightly lower than that of SOC testing (96%) for detecting C. trachomatis (P ‫؍‬ 0.167). For N. gonorrhoeae, the sensitivity of PS testing (90%) was significantly lower than that of SOC testing (99%) (P < 0.001). When pharynx-only infections were excluded, the sensitivity of PS testing to detect N. gonorrhoeae infections increased to 94%. Our findings show that pooling of self-taken samples could be an effective and cost-saving method, with high negative predictive values. (Interim results of this study were presented at the BASHH 2013 summer meeting.) I n the United States and Europe, genital Chlamydia trachomatis and Neisseria gonorrhoeae are the most prevalent bacterial sexually transmitted infections (STIs). In the United Kingdom, rates of gonorrhea and chlamydia among men who have sex with men (MSM) continue to rise (1), while studies highlight increases in the numbers of HIV-positive and HIV-negative MSM reporting high-risk sexual behavior since the advent of combination antiretroviral therapy (cART) (2-4).Coinfection with an STI and HIV has been shown to increase HIV transmission in epidemiological studies (5-7). Concomitant genital infections have been shown to increase shedding of HIV in the genital tract, in both vaginal secretions and seminal fluid (8, 9). Rectal C. trachomatis/N. gonorrhoeae infections have been associated with HIV acquisition in MSM (10), and it is plausible that they may also enhance HIV transmission.Nucleic acid amplification tests (NAATs) are being used increasingly to screen MSM for pharyngeal and rectal C. trachomatis/N. gonorrhoeae infections, in addition to the use of urethral or first-void urine (FVU) samples, and the use of NAATs is now recommended in national guidelines (11). While there are no NAATs licensed for use with extragenital specimens, several studies have demonstrated that NAATs perform well for the detection of both pharyngeal and rectal C. trachomatis/N. gonorrhoeae infections in . Studies evaluating the performance of these testing methodologies have demonstrated sensitivities and sp...

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“…gonorrhoeae, compared to clinician-collected specimens (15,16). This affords the possibility of testing MSM for STIs in nonclinical settings, including home sampling.…”

mentioning

confidence: 99%

The “3 in 1” Study: Pooling Self-Taken Pharyngeal, Urethral, and Rectal Samples into a Single Sample for Analysis for Detection of Neisseria gonorrhoeae and Chlamydia trachomatis in Men Who Have Sex with Men

et al. 2016

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“…Freeman et al reported that in 480 MSM who underwent OP CT testing by TMA on self-vs clinician-collected OP swabs, there was 99.4% agreement in results of the 2 testing methods; OP CT was detected in only 1.3% [33]; from an acceptability survey, they also reported that 92% of subjects were willing to self-collect an OP swab at home, 54% had no preference between self-vs clinician-collected strategy, and the majority agreed or strongly agreed that instructions were easy and the specimen was easy to collect. Feasibility and acceptability of MSM self-sampling for OP and rectal STIs was evaluated by Wayal et al, in which 301 subjects seen at a genitourinary medicine clinic were offered OP and rectal self-sampling options and then were provided with a questionnaire [34]. For up to 274 subjects with complete questionnaire data, feasibility and acceptability of self-sampling with OP gargle and mouth pad was higher than for OP swabs (92% and 96% vs 76%, respectively), and self-sampling with rectal swabs was acceptable to 82%.…”

Section: Discussionmentioning

confidence: 99%

“…Three studies identified evaluated CT detection by TMA on patient-collected vs provider-collected OP swabs [31][32][33], and 2 studies addressed acceptability of self-collecting OP specimens [33,34]. Sexton et al reported that 5 of 367 (1.4%) MSM had CT detected from a patient-or provider-collected OP swab, with all 5 MSM with CT-positive OP specimens having CT detected from patient-collected swabs vs only 3 of 5 detected from provider-collected OP swabs [31].…”

Section: Discussionmentioning

confidence: 99%

Diagnosis and Management of UncomplicatedChlamydia trachomatisInfections in Adolescents and Adults: Summary of Evidence Reviewed for the 2015 Centers for Disease Control and Prevention Sexually Transmitted Diseases Treatment Guidelines

Geisler

2015

Clin Infect Dis.

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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.Keywords. chlamydia; diagnosis; management; CDC; guidelines.Chlamydia trachomatis (CT) infection is the most frequently reported bacterial sexually transmitted infection in the United States and remains highly prevalent, with >1.4 million cases reported to the Centers for Disease Control and Prevention (CDC) annually [1]. Young age is a strong predictor of CT infection, with the highest CT infection prevalence in persons <25 years of age [1]. Because the majority of CT infections are asymptomatic, detection of infection often relies on screening. The 2010 CDC Sexually Transmitted Diseases (STD) Treatment Guidelines recommends annual CT screening in all sexually active women 25 years of age or younger and also older women with risk factors (eg, those who have a new sex partner or multiple sex partners) [2]. Benefits of CT screening in women have been demonstrated in areas where screening programs have reduced rates of pelvic inflammatory disease (PID) [3,4], a precursor of infertility, and recent literature suggests a continued decline in PID rates in the United States [5].The approach to the diagnosis and management of uncomplicated CT infection in adolescents and adults includes (1) CT testing using nucleic acid amplification tests (NAATs); (2) treatment with CDC-recommended therapy to reduce complications and prevent transmission to others; (3) treatment of sexual partners to prevent reinfection of patients and complications in patients and partners; (4) risk-reduction counseling; (5) repeat CT testing a few months following treatment to identify repeat infection; and (6) in pregnant women at a minimum of 3 weeks following treatment to identify persisting or repeat infection so that repeat treatment can be provided promptly to reduce risk for maternal and neonatal morbidity.Following release of the 2010 CDC STD Treatment Guidelines [2], unanswered questions and topics requiring further study on the epidemiology, diagnosis, and management of uncomplicated CT infection remained. In preparation for the 2015 CDC STD Treatment Guidelines, the CDC convened an advisory group in...

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“…This is particularly important for MSM, who are recommended to undergo multisite sampling, dependent on reported sexual risk. Opportunities for more comprehensive self-sampling do exist but are currently rather cumbersome: self-collected rectal and pharyngeal swabs appear to perform as well as provider-taken swabs and seem to be acceptable [180][181][182] but to our knowledge have not been evaluated in general practice. Self-collecting specimens for syphilis testing is feasible using dried blood from a finger prick and appeared to be acceptable in one study among MSM recruited from non-clinical settings.…”

Section: The Potential Of New Testing Technologiesmentioning

confidence: 99%

The Ballseye programme: a mixed-methods programme of research in traditional sexual health and alternative community settings to improve the sexual health of men in the UK

Estcourt

Sutcliffe

Mercer

et al. 2016

Programme Grants Appl Res

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is governor of the Wellcome Trust. Jackie Cassell reports funding from the NIHR HTA programme as principal investigator for the study 'The relative clinical effectiveness and cost-effectiveness of three contrasting approaches to partner notification for curable sexually transmitted infections: a cluster randomised trial in primary care' (reference number 07/43/01), for which the final report has been published [Cassell JA, Dodds J, Estcourt C, Llewellyn C, Lanza S, Richens J, et al. The relative clinical effectiveness and cost-effectiveness of three contrasting approaches to partner notification for curable sexually transmitted infections: a cluster randomised trial in primary care. This journal is a member of and subscribes to the principles of the Committee on Publication Ethics (COPE) (www.publicationethics.org/).Editorial contact: nihredit@southampton.ac.ukThe full PGfAR archive is freely available to view online at www.journalslibrary.nihr.ac.uk/pgfar. Print-on-demand copies can be purchased from the report pages of the NIHR Journals Library website: www.journalslibrary.nihr.ac.uk Criteria for inclusion in the Programme Grants for Applied Research journalReports are published in Programme Grants for Applied Research (PGfAR) if (1) they have resulted from work for the PGfAR programme, and (2) they are of a sufficiently high scientific quality as assessed by the reviewers and editors. Programme Grants for Applied Research programmeThe Programme Grants for Applied Research (PGfAR) programme, part of the National Institute for Health Research (NIHR), was set up in 2006 to produce independent research findings that will have practical application for the benefit of patients and the NHS in the relatively near future. The Programme is managed by the NIHR Central Commissioning Facility (CCF) with strategic input from the Programme Director.The programme is a national response mode funding scheme that aims to provide evidence to improve health outcomes in England through promotion of health, prevention of ill health, and optimal disease management (including safety and quality), with particular emphasis on conditions causing significant disease burden.For more information about the PGfAR programme please visit the website: http://www.nihr.ac.uk/funding/programme-grants-forapplied-research.htm This reportThe research reported in this issue of the journal was funded by PGfAR as project number RP-PG-0707-10208. The contractual start date was in February 2009. The final report began editorial review in May 2015 and was accepted for publication in December 2015. As the funder, the PGfAR programme agreed the research questions and study designs in advance with the investigators. The authors have been wholly responsible for all data collection, analysis and interpretation, and for writing up their work. The PGfAR editors and production house have tried to ensure the accuracy of the authors' report and would like to thank the reviewers for their constructive comments on the final report document. However, they do not accept...

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Self-sampling for oropharyngeal and rectal specimens to screen for sexually transmitted infections: acceptability among men who have sex with men

Cited by 58 publications

References 26 publications

The “3 in 1” Study: Pooling Self-Taken Pharyngeal, Urethral, and Rectal Samples into a Single Sample for Analysis for Detection of Neisseria gonorrhoeae and Chlamydia trachomatis in Men Who Have Sex with Men

The “3 in 1” Study: Pooling Self-Taken Pharyngeal, Urethral, and Rectal Samples into a Single Sample for Analysis for Detection of Neisseria gonorrhoeae and Chlamydia trachomatis in Men Who Have Sex with Men

Diagnosis and Management of UncomplicatedChlamydia trachomatisInfections in Adolescents and Adults: Summary of Evidence Reviewed for the 2015 Centers for Disease Control and Prevention Sexually Transmitted Diseases Treatment Guidelines

The Ballseye programme: a mixed-methods programme of research in traditional sexual health and alternative community settings to improve the sexual health of men in the UK

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