Women Find It Easy and Prefer to Collect Their Own Vaginal Swabs to Diagnose Chlamydia trachomatis or Neisseria gonorrhoeae Infections

Chernesky, Max; Hook, Edward W.; Martín, David H.; Lane, Jeannine R.; Johnson, Randy L.; Jordan, Jeanne A.; Fuller, D.; Willis, Dean; Fine, Paul; Janda, William M.; Schachter, Julius

doi:10.1097/01.olq.0000190057.61633.8d

Cited by 137 publications

(116 citation statements)

References 22 publications

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“…Many authors have advocated the use of self-taken vulvovaginal-swab specimens as suitable, acceptable, convenient, and effective in screening for C. trachomatis in a variety of clinical settings (5,25,26). Our study also showed that vulvovaginal-swab specimens collected at home and mailed to a laboratory are suitable diagnostic specimens for use with nucleic acid amplification tests.…”

Section: Discussionmentioning

confidence: 50%

Vulvovaginal-Swab or First-Catch Urine Specimen To Detect Chlamydia trachomatis in Women in a Community Setting?

et al. 2006

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Screening for chlamydia in women is widely recommended. We evaluated the performance of two nucleic acid amplification tests for detecting Chlamydia trachomatis in self-collected vulvovaginal-swab and first-catch urine specimens from women in a community setting and a strategy for optimizing the sensitivity of an amplified enzyme immunoassay on vulvovaginal-swab specimens. We tested 2,745 paired vulvovaginal-swab and urine specimens by PCR (Roche Cobas) or strand displacement amplification (SDA; Becton Dickinson). There were 146 women infected with chlamydia. The assays detected 97.3% (95% confidence interval [CI], 93.1 to 99.2%) of infected patients with vulvovaginal-swab specimens and 91.8% (86.1 to 95.7%) with urine specimens. We tested 2,749 vulvovaginal-swab specimens with both a nucleic acid amplification test and a polymer conjugateenhanced enzyme immunoassay with negative-gray-zone testing. The relative sensitivities obtained after retesting specimens in the negative gray zone were 74.3% (95% CI, 62.8 to 83.8%) with PCR and 58.3% (95% CI, 46.1 to 69.8%) with SDA. In community settings, both vulvovaginal-swab and first-catch urine specimens from women are suitable substrates for nucleic acid amplification tests, but enzyme immunoassays, even after negative-gray-zone testing, should not be used in screening programs.

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Section: Discussionmentioning

confidence: 50%

Vulvovaginal-Swab or First-Catch Urine Specimen To Detect Chlamydia trachomatis in Women in a Community Setting?

et al. 2006

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“…For women, the endocervical swab has been the standard sample for most tests approved by the U.S. Food and Drug Administration. Recently, however, the sensitivity for detection of chlamydial or gonococcal infection with vaginal swabs was shown to be similar to that with endocervical swabs (5,7,26). In the present study, endocervical swabs contained the highest C. trachomatis organism load (2231 EBs/100 l), followed by SCVSs (773 EBs/100 l), urethral swabs (162 EBs/100 l), and FVU specimens (47 EBs/100 l).…”

Section: Discussionmentioning

confidence: 63%

“…Potentially suitable clinical specimens for detection of chlamydial infection in women thus include urethral, vaginal, and endocervical swabs, self-inserted tampons, and FVU samples (3,12). For screening programs, noninvasive specimens, such as vaginal swabs, tampons, and FVU, are preferable to invasive urethral and endocervical swabs because they overcome several barriers associated with the traditional diagnostic pathway (5,11). Sensitivity of C. trachomatis detection with vaginal swabs has been shown to be similar to that with endocervical swabs or FVU samples (12,22,31).…”

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confidence: 95%

Chlamydia trachomatis Load at Matched Anatomic Sites: Implications for Screening Strategies

et al. 2007

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Urethral and endocervical swabs and self-collected vaginal swabs (SCVSs) and urine specimens are all used as samples for diagnosis of urogenital infection with Chlamydia trachomatis. We have now determined chlamydial organism load in matched specimens from different anatomic sites and examined its relation to clinical signs and symptoms in men and women. Organism load was measured with assays based on the ligase chain reaction or real-time PCR analysis. The mean organism loads in 58 infected men were 1,200 and 821 elementary bodies (EBs) per 100 l of sample for first-void urine (FVU) and urethral swabs, respectively (P > 0.05). Organism load in FVU samples or urethral swabs was positively associated with symptoms (P < 0.01) and clinical signs (P < 0.01) in men. The mean organism loads in 73 infected women were 2,231, 773, 162, and 47 EBs/100 l for endocervical swabs, SCVSs, urethral swabs, and FVU samples, respectively (P < 0.001 for each comparison). Only the presence of multiple symptoms or clinical signs was associated with organism load in women. These results show that FVU is a suitable noninvasive sample type for men, given the fact that its chlamydial load did not differ significantly from that of urethral swabs. Given their higher organism load compared with FVU, SCVSs are the preferred noninvasive sample type for women.Urogenital infection with Chlamydia trachomatis is the most commonly reported bacterial sexually transmitted infection (STI) and continues to be a major public health problem worldwide (4, 35). Given that most chlamydial infections are asymptomatic in both men and women, they often remain undiagnosed and untreated and therefore provide a reservoir for the disease (33). Infection of the upper genital tract may lead to complications, such as epididymitis in men and pelvic inflammatory disease in women. The inflammation and subsequent tissue scarring associated with the latter can lead to more serious sequelae (4).Effective control of chlamydial infection within a population requires early diagnosis and prompt treatment of asymptomatic individuals (28). Targeted and regular screening is also recommended for people in high-risk groups or with a past history of genital chlamydial infection (14). The most common sites of infection in women are the cervix and urethra. Infected cells are shed from the endocervix into the vagina and are present in vaginal secretions. Infected epithelial cells from the urethra and the associated C. trachomatis elementary bodies (EBs) can also be detected in first-void urine (FVU) (3, 16). Potentially suitable clinical specimens for detection of chlamydial infection in women thus include urethral, vaginal, and endocervical swabs, self-inserted tampons, and FVU samples (3, 12). For screening programs, noninvasive specimens, such as vaginal swabs, tampons, and FVU, are preferable to invasive urethral and endocervical swabs because they overcome several barriers associated with the traditional diagnostic pathway (5, 11). Sensitivity of C. trachomatis detection with vag...

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“…Previous reports indicate that self-sampling under optimal conditions in clinical or supervised settings is both accurate (8)(9)(10)(11)(12)(13)(14)(15) and preferred by patients (16)(17)(18)(19). In a recent systematic review, the sensitivity and specificity of self-sampling for identifying high-risk HPV were 74% and 88% compared with physician sampling (12).…”

Section: Introductionmentioning

confidence: 99%

Self-Sampling for Human Papillomavirus in a Community Setting: Feasibility in Hispanic Women

Alba¹,

Anton‐Culver²,

Hubbell³

et al. 2008

Cancer Epidemiology, Biomarkers &Amp; Prevention

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Background: The aim of the study was (a) to assess sensitivity and specificity of self-sampling in a community setting for identifying high-risk human papillomavirus (HPV) infection and abnormal Papanicolaou (Pap) smears and (b) to assess satisfaction with this collection method among Hispanic women. Methods: Lay health workers distributed self-collection kits to Hispanic women in the community. Participants collected an unsupervised vaginal sample at home or in the place and time of their preference. Results: A total of 1,213 Hispanics were included and provided a self-sample for HPV testing and were invited for a Pap smear; 662 (55%) of them had a Pap smear and the first 386 of these also had a physician-collected sample for HPV retesting. Using physician collection as the gold standard, unsupervised

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Women Find It Easy and Prefer to Collect Their Own Vaginal Swabs to Diagnose Chlamydia trachomatis or Neisseria gonorrhoeae Infections

Abstract: Self-collected vaginal swabs were easy to collect and patients preferred them over urine and cervical swabs.

Cited by 137 publications

References 22 publications

Vulvovaginal-Swab or First-Catch Urine Specimen To Detect Chlamydia trachomatis in Women in a Community Setting?

Vulvovaginal-Swab or First-Catch Urine Specimen To Detect Chlamydia trachomatis in Women in a Community Setting?

Chlamydia trachomatis Load at Matched Anatomic Sites: Implications for Screening Strategies

Self-Sampling for Human Papillomavirus in a Community Setting: Feasibility in Hispanic Women

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