Self-obtained vaginal swabs for Neisseria gonorrhoeae and Chlamydia trachomatis found to be non-inferior to provider administrated sampling

1. Among patients presenting in the emergency setting for possible sexually transmitted infection, a self-obtained vaginal swab was found to be non-inferior to provider-performed endocervical sampling for the diagnosis of Neisseria gonorrhoeae and Chlamydia trachomatis.

Evidence Level Rating: 1 (Excellent)

Neisseria gonorrhoeae (NG) and Chlamydia trachomatis (CT) are the two most common sexually transmitted infections (STI) reported in the U.S. In the emergency setting, NG/CT is diagnosed via nucleic acid amplification test (NAAT), with the most common method of collection being provider-performed endocervical sampling (PPES). However, PPES may be uncomfortable, intrusive, or refused by some patients. As such, this prospective cohort study sough to establish whether self-obtained vaginal swabs (SOVS) were non-inferior to PPES for the diagnosis of NG/CT. A minimum sensitivity of 90% was established for SOVS to be considered clinically non-inferior to standard PPES. 515 patients were included for analysis (mean [SD] age = 30.7 [9.9] years). The majority of patients (95%) reported at least one vaginal/pelvic/urinary symptom, and 45% had a prior history of STI. Patients underwent both PPES and SOVS; 29 had infection with NG, 47 with CT, and 10 with both. It was found that SOVS had a sensitivity of 95% (95% CI 88% to 99%) for the detection of NG/CT when compared with PPES. There were three false-negative CT diagnoses and one false-negative NG diagnosis. With regards to organism-specific results, SOVS had a sensitivity of 97% (95% CI 87% to 100%) for NG and 94% (95% CI 84% to 99%) for CT. Thus, the non-inferiority of SOVS to PPES for the diagnosis of NG/CT in the emergency setting was established. It should be emphasized that SOVS was not proposed as a replacement for pelvic exams; indeed, a comprehensive physical examination remains of the utmost importance, especially for undifferentiated patients in an emergency setting. Rather, SOVS has the potential to optimize workflow in the emergency setting by allowing for earlier collection of samples and more timely initiation of treatment.

Click to read the study in SAEM

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