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

Sultan, Binta; White, John Albert; Fish, Rebecca; Carrick, G; Brima, Nataliya; Copas, Andrew; Robinson, Angela; Gilson, Richard; Mercey, D; Benn, Paul

doi:10.1128/jcm.02460-15

Cited by 52 publications

(81 citation statements)

References 25 publications

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“…Pooling of urine specimens from multiple individuals has been shown to be sensitive and specific for CT testing15 16 and the effectiveness of pooling specimens from different anatomical sites within an individual for CT and NG detection has been demonstrated previously 11. These workers tested throat and rectal swabs and urine samples in MSM using the AC2 assay and demonstrated high negative predictive values for pooled sample testing.…”

Section: Discussionmentioning

confidence: 95%

“…It is possible that the dilutional effect of the urine in the pooled specimens was responsible for the apparent reduced sensitivity for the solitary rectal CT infections. Sultan et al 11 also found single site infections accounted for almost all of their missed CT and NG infections with pooled specimen testing, but found the throat swabs were less sensitive than the rectal swabs. Direct comparison of pooled testing and individual specimen testing using the GeneXpert would help address this.…”

Section: Discussionmentioning

confidence: 98%

“…There are limited data on the use of NAATs for the detection of CT and NG using pooled specimens. Sultan et al 11 studied pharyngeal, rectal and urine specimens in MSM by comparing single sample analysis with pooled remaining samples using the Aptima Combo 2 TMA assay (AC2) (Hologic, San Diego, CA, USA). For their cohort of 164 CT and 288 NG detections from single sample testing they found the sensitivity of pooled sampling to be slightly lower but not significantly different (p=0.167) for CT (92% vs 96%); however, pooled sampling was significantly lower (p<0.001) for NG (90% vs 99%), resulting in 13 missed CT infections and 31 missed NG infections.…”

Section: Introductionmentioning

confidence: 99%

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Detection of Neisseria gonorrhoeae and Chlamydia trachomatis from pooled rectal, pharyngeal and urine specimens in men who have sex with men

Speers¹,

Chua

Manuel

et al. 2017

Sex Transm Infect

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Section: Discussionmentioning

confidence: 95%

Section: Discussionmentioning

confidence: 98%

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Detection of Neisseria gonorrhoeae and Chlamydia trachomatis from pooled rectal, pharyngeal and urine specimens in men who have sex with men

Speers¹,

Chua

Manuel

et al. 2017

Sex Transm Infect

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“…National data from the Netherlands suggests that a majority of chlamydial and gonococcal infections in MSM would be missed if extragenital sites are not tested (77), although there is no published cost effectiveness data to compare this strategy with history-directed testing. Pooling of samples from pharynx, urine and rectum may be a means of reducing costs (78). It is desirable that hepatitis B vaccination is offered in all settings but the advantages of expanding the availability of HIV and STI testing should not be lost if this is not practicable in outreach situations.…”

Section: The Range Of Tests Providedmentioning

confidence: 99%

2016 United Kingdom national guideline on the sexual health care of men who have sex with men

et al. 2018

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This guideline is intended for use in UK Genitourinary medicine clinics and sexual health services but is likely to be of relevance in all sexual health settings, including general practice and Contraception and Sexual Health (CASH) services, where men who have sex with men (MSM) seek sexual health care or where addressing the sexual health needs of MSM may have public health benefits. For the purposes of this document, MSM includes all gay, bisexual and all other males who have sex with other males and both cis and trans men. This document does not provide guidance on the treatment of particular conditions where this is covered in other British Association for Sexual Health and HIV (BASHH) Guidelines but outlines best practice in multiple aspects of the sexual health care of MSM. Where prevention of sexually transmitted infections including HIV can be addressed as an integral part of clinical care, this is consistent with the concept of combination prevention and is included. The document is designed primarily to provide guidance on the direct clinical care of MSM but also makes reference to the design and delivery of services with the aim of supporting clinicians and commissioners in providing effective services. Methodology This document was produced in accordance with the guidance set out in the BASHH CEG’s document ‘Framework for guideline development and assessment’ published in 2010 at http://www.bashh.org/guidelines and with reference to the Agree II instrument. Following the production of the updated framework in April 2015, the GRADE system for assessing evidence was adopted and the draft recommendations were regraded. Search strategy (see also Appendix 1) Ovid Medline 1946 to December 2014, Medline daily update, Embase 1974 to December 2014, Pubmed NeLH Guidelines Database, Cochrane library from 2000 to December 2014. Search language English only. The search for Section 3 was conducted on PubMed to December 2014. Priority was given to peer-reviewed papers published in scientific journals, although for many issues evidence includes conference abstracts listed on the Embase database. In addition, for ‘Identification of problematic recreational drug and alcohol use’ section and ‘Sexual problems and dysfunctions in MSM’ section, searches included PsycINFO. Methods Article titles and abstracts were reviewed and if relevant the full text article was obtained. Priority was given to randomised controlled trial and systematic review evidence, and recommendations made and graded on the basis of best available evidence. Piloting and feedback The first draft of the guideline was circulated to the writing group and to a small group of relevant experts, third sector partners and patient representatives who were invited to comment on the whole document and specifically on particular sections. The revised draft was reviewed by the CEG and then reviewed by the BASHH patient/public panel and posted on the BASHH website for public consultation. The final draft was piloted before publication. Guideline update The guidelines will be reviewed and revised in five years’ time, 2022.

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“…Extra genital screening tests patients in their genital, urethral, and pharyngeal sites. Although urine is most widely used to test for CT/GC infection, it is still recommended to test all three sites as an individual's sexual practices can place them at greater risk for infection, depending on the type of sex they are having (13,15) . Information on the underlying disparities regarding prevalence and incidence of disease is necessary for bridging the gap in services.…”

Section: Introductionmentioning

confidence: 99%

Missed Opportunities of Chlamydia and Gonorrhea Detection When Not Using Extra Genital Screening Among Males

Schafer

Prado

Barin

et al. 2018

Preprint

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The number of Chlamydia trachomatis (CT) and Neisseria gonorrhoeae (GC) infections missed were determined using extra genital screening procedures among male patients from the Long Beach Department of Health and Human Services (LBDHHS), STD/Family Planning Clinic. This method tests urethral, pharyngeal, and rectal sites for CT and GC infection. In this retrospective medical review of 1,569 patient files, of which 242 tested positive, the proportion of male cases that would have remained undetected for CT/GC if using urethral screening only were detected. Abstract Background Through extra genital screening methods, Health Departments and community clinics can increase detection of sexually transmitted diseases (STDs) through the application of urethral testing. The Long Beach Department of Health and Human Services (LBDHHS) works on preventing cases Chlamydia trachomatis (CT) and Neisseria gonorrhoeae (GC) infection from being undiagnosed, by providing extra genital screening. Methods Retrospective medical review of 1,569 patient health records, who received CT/GC testing, based on at least one visit to the LBDHHS, STD Clinic, from 2012 to 2015. All male patients ages 18 years or older with positive CT/GC results (n=242) for urethral, rectal, and pharyngeal sites; regardless of their sexual behaviors, were included in the study. Females, those under the age of 18, and patients who tested negative for all three anatomical sites were excluded (n=1,327). ResultsAt time of collection, study participants had a mean age of 37 years. Reported ethnicity indicated 56% Caucasian, 21% Hispanic or Latino, 9% Asian or Pacific Islander, 7% Other, 5% Black, and 2% More than one race. The use of extra genital screening detected 15% (n=242) of the 1,569 patients tested positive for at least one type of CT/GC infection. These findings demonstrated that if urine were the only specimen collected, then over 29.7% of CT and 46.8% of GC cases would have been missed. ConclusionsTesting of all three anatomical sites should continue to be performed for CT/GC detection. Cases of CT/GC are underreported if performing urethral screening alone. These testing measures may reduce the potential for missing a diagnosis, mitigating transmission, as well as prevention and control.

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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

Cited by 52 publications

References 25 publications

Detection of Neisseria gonorrhoeae and Chlamydia trachomatis from pooled rectal, pharyngeal and urine specimens in men who have sex with men

Detection of Neisseria gonorrhoeae and Chlamydia trachomatis from pooled rectal, pharyngeal and urine specimens in men who have sex with men

2016 United Kingdom national guideline on the sexual health care of men who have sex with men

Missed Opportunities of Chlamydia and Gonorrhea Detection When Not Using Extra Genital Screening Among Males

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